Authors: Thiruselvi Subramaniam, Rosalind Chi Neo Loo, Sangeetha Poovaneswaran.

ABSTRACT

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a one-day course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment.

Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS).

Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test.

Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts.

Conclusion: There is a significant difference in medical  students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.

Keywords: basic life support (BLS), cardiac life support (CLS), cardiac resuscitation, mega codes, simulation, manikins.

Citation: IeJSME 2014 8(3): 4-8

DOI: https://doi.org/10.56026/imu.8.3.4

Authors: Hui Meng Er, Srinivasan Ramamurthy, Peter CK Pook.

ABSTRACT

Background: The widespread use of multiple choice questions (MCQ) in examinations is attributed to its logistical advantage and broad coverage of content within a short duration. The end-of-semester examinations for several modules in the pharmacy programme previously employed a combination of written examination tools including MCQ, short answer questions (SAQ) or essays for assessing learning outcomes in the cognitive domain. Concerns regarding assessment fatigue and subjectivity in marking have led to a review of the assessment formats in the examinations. Various types of MCQ were consequently introduced as the only assessment tool. This study was conducted to evaluate the performance of students in the examinations as a result of the change.

Methodology: Analyses were carried out on the end-of-semester examination results of two cohorts of students for each module, one based on a combination of MCQ, SAQ or essay and the other based on MCQ alone. The class means were compared, and t-test was used to determine the difference between the performances.

Results: Although the difference in the mean scores of the two groups is statistically significant in 13 of the 20 modules, the difference is less than 5% in 10 modules.

Conclusion: The findings provide evidence that wellconstructed MCQ can effectively assess cognitive skills.

Keywords: Cognitive; learning outcomes; multiple choice questions; pharmacy; written examination.

Citation: IeJSME 2014 8(3): 9-18

DOI: https://doi.org/10.56026/imu.8.3.9

Authors: Sharifah Sulaiha Syed Aznal, Chee Yoong Wong, Pamela Lee Ling Tan, Vee Vee See, Chui King Wong.

ABSTRACT

Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes.

Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected.

Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery.

Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.

Keywords: Affecting factors, pregnancy, mental preparedness, factors, birth outcome.

Citation: IeJSME 2014 8(3): 19-27

DOI: https://doi.org/10.56026/imu.8.3.19

Authors: Stephen Ambu, Stacey Foong Yee Yong, Yvonne Ai Lian Lim, Mak Joon Wah, Donald Koh Fook Chen, Soo Shen Ooi, Sau Peng Lee, Ti Myen Tan, Mei Yen Goh, Danapridha Nyanachendram.

ABSTRACT

Background: The public health issue of consuming groundwater is a major concern because people often extract groundwater directly from the aquifers either through wells or boreholes without treating it with any form of filtration system or chlorine disinfection. Based on the Malaysian National Drinking Water guidelines the current study was designed to provide a better understanding on the variable factors that are influencing the quality of well-water in an urbanised village in Malaysia. Well water quality assessment of heavy metals, chemicals, microbial and physical parameters were carried out for Sungai Buloh Village in the Klang Valley to ensure it was safe for human consumption.

Materials and Methods: Water samples were collected from wells at four sites (Sites A,B,C,D), a river and a tap inside a house in Sungai Buloh village. Soil was sampled from the riverbed and area surrounding the wells. Samples were collected every two months over a one year duration from all sites. The water samples were processed and examined for viruses, coliforms and protozoa as well as for heavy metal contaminants.

Results: The turbidity and colour ranged in the average of 0.57-0.13 Nephelometric Turbidity (NTU) and 4.16-5.00 Total Conjunctive Use (TCU) respectively for all sites except Site C. At Site C the turbidity level was 2.56 ± 1.38 NTU. The well-water was polluted with coliforms (1.2 to 2.4 x 103 CFU/100 ml) in all sites, E. coli (0.12 – 4 x 102 CFU/100 ml CFU/ 100 ml) and Cryptosporidium oocysts (0.4 cysts/100 ml). All the heavy metals and chemical parameters were within the Malaysian Guidelines’ limits except manganese. The average pH ranged from 5.44 – 6.62 and the temperature was 28 ºC.

Conclusion: In summary, the well water at Sungai Buloh is considered unsafe for consumption due to pollution. Therefore the major thrust will be to provide better quality of drinking water to the residents of the village.

Keywords: well water, microbial, heavy metal, chemical, urbanised village, public health.

Citation: IeJSME 2014 8(3): 28-44

DOI: https://doi.org/10.56026/imu.8.3.28

Authors: Vaani Valerie Visuvanathan, Hui Min Chong, Shien Yee Ng, Chen Nee Ch’ng, Juliana Shook Shin Tan, Sree Viknaraja Arun Kumar, Ming Wai Wan.

ABSTRACT

Background: Community-acquired pneumonia (CAP) is the most important cause of hospitalisation in Malaysia and the 6th most important cause of mortality in patients aged 65 years and above. CAP is a lower respiratory tract infection that includes signs and symptoms like cough, fever, dyspnoea, the presence of new focal chest signs and new radiographic shadowing with no prior cause. To assist clinical judgement in deciding whether to admit the patient for in-ward treatment or otherwise, the severity of CAP is most commonly graded using the CURB-65 score as the components are more readily accessible in the Accidents and Emergency Department. We believe that cardiopulmonary diseases, immunosuppressive diseases like HIV infection or diabetes mellitus and other co-morbidities may affect the severity of CAP and are thus aspects of a patients’ history that should play a more significant role in influencing a clinician’s judgement of CAP severity. The general objective of the study is therefore to identify the relationship between co-morbidities and initial severity assessment of a patient admitted for community acquired pneumonia. The 3 specific objectives are i) to determine if presence of co-morbidities affects initial severity assessment in a patient admitted with CAP ii) To identify which co-morbidities affects initial severity
assessment and iii) to determine whether having multiple co-morbidities increases initial severity assessment.

Methodology: A retrospective study was carried out from the month of February 2013 to July 2013 at Hospital Tuanku Ja’afar, Seremban (HTJS). Patients admitted to the four Medical wards – 6A, 6B, 7A, and 7B – from July 2012 to December 2012 and have been diagnosed with CAP were chosen. A checklist was used as a survey instrument. Using statistical analysis, the severity of CAP in patients was compared in patients with different factors like gender, different co-morbidities and the number of co-morbidities.

Results: A total of 63 patients in the control group had no co-morbidities and 54 patients were of low risk, 7 patients had moderate risk, and 2 patients had high risk CAP. Of the remaining 337 patients in the sample population, 124 patients had one co-morbidity, while 213 patients had multiple co-morbidities. Among those with a single co-morbidity, 100 patients had low risk, 19 patients had moderate risk, and 5 patients had high risk CAP. For the group with multiple co-morbidities, 135 patients had low risk, 58 patients had moderate risk, and 20 patients had high risk CAP. This study found that the presence and number of co-morbidities present in a patient affected the severity of CAP. Co-morbidities like diabetes mellitus, hypertension and asthma had significant correlation to the severity of CAP in patients. The gender of the patient had no significant correlation to the severity of CAP.

Conclusion: The presence and number of co-morbidities present in a patient increases the severity of CAP. Hypertension, diabetes mellitus, and asthma are comorbidities that are prerequisites for increased caution and alert when judging the severity of CAP in patients. Comparison of patients with single and multiple comorbidities showed that patients in the latter group present with higher severity scores (p-value = 0.004).

Keywords: Co-morbidities, CURB-65 risk score, Community Acquired Pneumonia, retrospective, random sampling.

Citation: IeJSME 2015 9(1): 32-37

DOI: https://doi.org/10.56026/imu.9.1.32

Authors: Siew Kim Kwa, Zainab Majeed, Shane Varman.

ABSTRACT

Introduction: Assessment is an integral aspect of teaching. One-best-answer (OBA) items, if properly constructed are able to drive learning. In-house OBA items are notoriously poorly-constructed. The role of a central vetting committee is to review test items and ensure that they adhere to expected standards. Hence, the objective of this audit is to determine whether central vetting has improved the construct quality of OBA items.

Methods: We audited the psychiatry end-of posting OBA items from before and after central vetting to compare the quality of the items before and after central vetting was instituted. Quality was evaluated on appropriateness of test content, items with higher cognition and items without flaws. A standard was not set for this first audit.

Results: Seventy six of 181 psychiatry OBAs items retrieved from 2011 to August 2012 had undergone first level (department) vetting only and the remainder 105 (58.0%) had two levels of vetting; department and central vetting committee (CVC). Appropriateness of content increased from 92.1% to 98.1%. Items with higher order thinking doubled from 21.1% to 42.9%. Items with clinical scenario increased by 8.4% to 78.1%. Logical ordering of options however, remained around 50%. Two-level vetting markedly reduced problematic lead-in questions (67.1 to 13.3%), non-homogenous options (42.1 to 9.5%), vague and implausible options (39.5 to 6.7%), and spelling and grammar mistakes (19.7 to 5.7%).

Conclusion: Two-level vetting had improved the quality of OBAs and should be continued. This could be enhanced by training all Faculty on writing quality OBA items and careful selection and empowerment of CVC members. A re-audit is to be conducted after Faculty training.

Keywords: Assessment, Vetting, One-best-answer items, MCQ, Quality assurance.

Citation: IeJSME 2017 11(3): 3-9

DOI: https://doi.org/10.56026/imu.11.3.3