Quality Of Life And Disability In Alcohol And Drug Dependent Patients Undergoing Treatment At Depaul House

Posted Posted in Original Article

Authors: George Philip, Whelan Greg, Nicolle Ait Khelifa.

ABSTRACT

Quality of life and disability are important indices that may help change the perception, treatment and care of those with alcohol or drug dependence problem. A cross-sectional survey was done among 25 drug and 25 alcohol dependents consecutively admitted to a community based residential withdrawal service in Melbourne, Australia to assess their quality of life and disabilities using the World Health Organisation Quality of Life (WHOQoL)-Bref and the World Health Organisation Disability Assessment Scale (WHODAS) questionnaires. The quality of life of the sample population was found to be significantly poorer than the general population. The scores on quality of life and disability measurements in the group of patients with alcohol dependence were similar to the other drug dependent group.

Keywords: quality of life, disability, drug, alcohol dependents.

Citation: IeJSME 2007: 1 (1): 35-40

Assessment Of Basic Practical Skills In An Undergraduate Medical Curriculum

Posted Posted in Original Article

Authors: Sambandam Elango, Ramesh C Jutti, Palayan Kandasami, Cheong Lieng Teng, Li Cher Loh, Tirathram Motilal.

ABSTRACT

Introduction: Health educators and accrediting bodies have defined objectives and competencies that medical students need to acquire to become a safe doctor. There is no report in Malaysia, about the ability of medical students to perform some of the basic surgical skills before entering the houseman ship. The aim of this study is to determine whether the teaching/ learning methods of practical skills in our undergraduate program have been effective in imparting the desired level of competencies in these skills.

Methods: A list of basic practical skills that students should be competent has been identified. These skills are taught in a structured way and assessed as part of the composite end-of-semester examination. Practical skills stations form part of an Objective structured practical examination (OSPE).

Results: The results of 244 students who participated in three ends of semester examinations were analyzed. The mean score for the practical skills stations were higher than the mean OSPE (of all 18 stations) and overall score (of the written, practical and clinical examination). However the failure rate in the practical skills stations is higher in most of the stations (7 out of 8 stations) compared to overall failure rates.

Conclusions: In spite of the formal skills training many students failed to demonstrate the desired level of competencies in these stations. Assessment of practical skills as part of overall composite examination may not be effective in ensuring that all students have achieved the required level of competency. Practical skills should be assessed through dedicated formative assessments to make sure that all the students acquire the required competencies.

Keywords: clinical competence, practical skills, assessment.

Citation: IeJSME 2007: 1 (1): 41-45

Ethnic Differences and Motivation Based on Maslow’s Theory at a Medical University

Posted Posted in Original Article

Author: Jagmohni Kaur Sidhu

ABSTRACT

Introduction: Motivation in Malaysia is to a large extent influenced by the value system amongst all Malaysians. Being able to motivate employees is one of the important keys to the success of the organization. In this paper, an attempt was made to look into the needs of employees in organizations and in particular, the needs based on Maslow’s theory on motivation.

Subjects and Methods: Employees which consisted of both academic and administrative employees of the International Medical University (IMU) were surveyed using a standard questionnaire. The aim of this study was to compare which levels of Maslow’s hierarchy of needs theory had been fulfilled and which needs were yet to be fulfilled in the different ethnic groups at IMU.

Results: Amongst the males, the Chinese and Indian ethnic groups placed most emphasis on the esteem needs and on self-actualization needs. The Malay males gave importance to Safety needs. Amongst the female ethnic groups, all three groups placed most importance on the esteem needs and self-actualization needs. The Chinese females scored the lowest for the Basic needs compared to the Malay and Indian females. The Indian females scored the lowest for Social needs.

Conclusion: Organisations should play an important role in the motivation of employees. Human resource development is an integral part in the development of its employees.

Keywords: Maslow, motivation, ethnic, medical, university.

Citation: IeJSME 2007: 1 (1): 46-51

Cercarial Dermatitis In Kelantan, Malaysia An Occupation Related Health Problem

Posted Posted in Original Article

Authors: Chiew Eng Wooi, Susan Lim Lee Hong, Stephen Ambu.

ABSTRACT

Introduction: Kelantan, an east coast state of Peninsular Malaysia is rich in culture and supports a population that is dependent on agriculture. The crops cultivated are mainly paddy and rubber but in recent years tobacco is beginning to gain importance over paddy. We centered our study around Bachok District which is about 25 kilometers east of Kota Bharu, the state capital.

Methods: Based on case reports we focused our study on cercarial dermatitis and also recorded the socioeconomic status of the people in the four study villages.

Result: The ducks and cows were the common livestock kept by the farmers and these were found to be significantly associated (P=0.05) with the occurrence of dermatitis. Cercariae shedding by snails were found in waters used for irrigation.

Conclusion: The results indicate that cercarial dermatitis is occupation specific, and its debilitating effect was having an influence on the socioeconomic status and general wellbeing of the population in these villages. The dermatitis occurred only during the field preparation and transplanting stages of paddy and was found to be significantly associated (P=<0.05) with the source of water used for irrigation. The water sources for irrigation was mainly from the river and irrigation canal and the snail Indoplanorbis exustus infected with schistosome cercariae was found to be abundant in both these sources during these stages. The ducks and cows were the common livestock kept by the farmers and these were also found to be significantly associated (P=0.05) with the occurrence of dermatitis. Therefore we concluded that the dermatitis among paddy farmers in Bachok District was due to an animal schistosome.

Keywords: Environment, Occupational health, Disease vectors, Zoonoses.

Citation: IeJSME 2007: 1 (2): 69-73

Sputum Bacteriology And In-Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary-Referral Hospital – A Retrospective Study

Posted Posted in Original Article

Authors: Yow-Wen Chin, Li-Cher Loh, Thim-Fatt Wong, Abdul Razak Muttalif.

ABSTRACT

Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics.

Methods: From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed.

Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems.

Conclusion: In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.

Keywords: Antibiotic sensitivity, Community-acquired pneumonia, Penang hospital, Sputum bacteriology.

Citation: IeJSME 2007: 1 (2): 74-79

Prevailing Practice Versus Clinical Guideline: The In-Patient Assessment And Management Of Childhood Bronchopneumonia In A Malaysian District Hospital

Posted Posted in Original Article

Authors: Jacynta Jayaram, Nai Ming Lai, Kin Wai Foong, Sit Zaleha Mohammad Salleh.

ABSTRACT

Introduction: Pneumonia is the most common diagnosis made in hospitalised children. The Malaysian Clinical Practice Guidelines on pneumonia and respiratory tract infections provides a comprehensive guidance in the local context. We evaluated the documented assessment and management of children diagnosed with pneumonia admitted to the children’s ward, Hospital Batu Pahat against this guideline.

Methods: We performed a retrospective analysis of hospital case notes for children admitted from January to May 2004.

Results: Ninety six case notes were analysed. Most patients (84%) had at least four positive clinical features leading to the diagnosis of pneumonia. 92% met the guideline criteria for admission. Sp02 was performed for 58% on admission, and 58% with reading below 95% received supplemental oxygen. Throughout hospital stay, each patient had an average of four investigations (range: 1 – 12). Among 23 patients who had further investigations, justifications were only recorded in seven patients (30.4%), and changes in management resulted in 23%. The most common antibiotic prescribed was intravenous Penicillin (97 %). In 17 patients who met the guideline classification for severe pneumonia, none received the recommended antibiotic combination. The median time to fever resolution was 22 hours (range 2 – 268), and median hospital stay was 3 days (range 1 – 12).

Conclusions: Although the quality of clinical assessment and antibiotic choices were acceptable, there was a failure to critically evaluate patients according to disease severity and initiate corresponding investigations and managements. Future efforts need to be directed at promoting further guideline adherence and the exercise of critical judgment in patient evaluation.

Keywords: Bronchopneumonia, children, clinical audit, hospitals, district.

Citation: IeJSME 2008: 2 (2): 9-16

Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)

Posted Posted in Original Article

Authors: C K Ong, W C Tan, K N Leong, A R Muttalif.

ABSTRACT

The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3), patients with CD4 counts ² 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ² 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.

Keywords: CD4 Counts; HIV-1; HIV-TB Co-infection; Mantoux test; Tuberculosis.

Citation: IeJSME 2008: 2 (2): 17-22

PET-CT Imaging In Non-Small Cell Lung Carcinoma – A Review of Cases from A Northern Malaysia Referral Centre

Posted Posted in Original Article

Authors: Joni Bing Fei Teoh, Vikneswary Paniandi, Fadzilah Hamzah H, Mohamed Ali Abdul Khader, Li-Cher Loh.

ABSTRACT

Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed.

Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma.

Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy.

Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis.

Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.

Keywords: Carcinoma, Non-Small-Cell Lung; Positron emission tomography; Computed tomography; Malaysia.

Citation: IeJSME 2008: 2 (2): 23-26

The Levels Of Difficulty And Discrimination Indices In Type A Multiple Choice Questions Of Pre-clinical Semester 1 Multidisciplinary Summative Tests

Posted Posted in Original Article

Authors: Mitra N K, Nagaraja H S, Ponnudurai G, Judson J P.

ABSTRACT

Item analysis is the process of collecting, summarizing and using information from students’ responses to assess the quality of test items. Difficulty index (P) and Discrimination index (D) are two parameters which help evaluate the standard of MCQ questions used in an examination, with abnormal values indicating poor quality. In this study, 120 test items of 12 Type A MCQ tests of Foundation 1 multi-disciplinary summative assessment from M2 / 2003 to M2 / 2006 cohorts of International Medical University were selected and their P-scores in percent and D-scores were estimated using Microsoft Office Excel. The relationship between the item difficulty index and discrimination index for each test item was determined by Pearson correlation analysis using SPSS 11.5. Mean difficulty index scores of the individual summative tests were in the range of 64% to 89%. One-third of total test items crossed the difficulty index of 80% indicating that those items were easy for the students. Sixty seven percent of the test items showed acceptable (> 0.2) discrimination index. Forty five out of 120 test items showed excellent discrimination index. Discrimination index correlated poorly with difficulty index (r = -0.325). In conclusion, a consistent level of test difficulty and discrimination indices was maintained from 2003 to 2006 in all the twelve summative type A MCQ tests.

Keywords: Item analysis, difficulty index, discrimination index, type A MCQ, summative tests.

Citation: IeJSME 2009: 3 (1): 2-7

Task-Based Learning: Student’s Perception Of Their Skill In Participating In Small Group Discussions

Posted Posted in Original Article

Authors: Sharifah Sulaiha S A, Nurjahan M I, Nagarajah Lee.

ABSTRACT

Introduction: Task-based learning (TBL) has been accepted as an effective tool in teaching and learning activities in most medical schools. Many studies have looked at competencies and learning outcomes essential for undergraduates. Among the essential competencies are interpersonal skills and the ability to engage in a group discussion which this study has focused on. The evidence supporting higher interpersonal skills is however limited because many relevant competencies are hard to measure and require long observational periods.

Objective: To determine students’ self-perceived value of TBL in enhancing their interpersonal skills during the clinical phase.

Material and Methods: All students’ (semesters 6-10) in the clinical school of International Medical University (IMU) were invited to participate in this cross-sectional study done in December 2007 utilising a self-administered questionnaire with a 5-point Likert scale. It assessed the students’ perception on TBL sessions conducted during their clinical attachments in the various disciplines. Mean-scores, standard deviations, and confidence interval were used.

Results: Response rate was 62%. The results indicated that students were favorable in their opinion on TBL as a suitable forum for active communication and participation in group discussion. The results also show that both male and female students’ have similar perception. As for the comparison according to semesters, this showed that students’ maturity does not influence their perception as well.

Conclusion: In conclusion, the study has shown positive students’ perception on the effect of TBL on acquired skills such as interpersonal communication. Our findings are consistent with many earlier studies which show students’ perception of the method of learning as important factor in the enhancement of their interpersonal skills which is fundamental to clinical practice. Further research is necessary; long-term and larger scale observational studies would undoubtedly be optimal to minimise response bias.

Keywords: Task-based learning, interpersonal skill, communication skill, medical school.

Citation: IeJSME 2009: 3 (1): 8-12