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

DOI: https://doi.org/10.56026/imu.2.2.9

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

DOI: https://doi.org/10.56026/imu.2.2.17

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

DOI: https://doi.org/10.56026/imu.2.2.23

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

DOI: https://doi.org/10.56026/imu.3.1.2

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

DOI: https://doi.org/10.56026/imu.3.1.8

Author: Collin Looi Seng-Kim

ABSTRACT

Background: To assess the effect of cement vertebroplasty on the activity of daily living of elderly patients who have sustained a vertebral osteoporotic fracture.

Patients and Methods: Seven patients with clinically significant and radiologically proven osteoporotic vertebral compression fractures suitable to be treated with percutaneous cement vertebroplasty were recruited. Evaluation was based on pre- and postprocedure activity by clinical documentation (including interview) and by a self-developed questionnaire (including quality of life).

Results: Following the procedure, 54% of patients resumed their activities of daily living with minimal pain while 46% of patients were able to do so without any pain (p<0.05). Up to 85% of patients did not require any form of medication (p<0.05) and 77% of patients were found to have no pain. In addition to that, almost 62% of patients were able to ambulate normally.

Conclusion: Percutaneous cement vertebroplasty appears to significantly improve the activities of daily living of elderly patients who have sustained vertebral osteoporotic fractures. It is also found to be a safe procedure which contributes to reduced usage of medication, immediate pain reduction and improvement in functional status of the patient.

Keywords: Percutaneous cement vertebroplasty, quality of life, daily activity.

Citation: IeJSME 2009: 3 (2): 8-13

DOI: https://doi.org/10.56026/imu.3.2.8

Authors: Patil Sapna S, Hasamnis Ameya A, Pathare Rooma S, Parmar Aarti, Rashid A K, Narayan K A.

ABSTRACT

Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired.

Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis.

Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother, parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p<0.001). Multivariate logistic regression analysis revealed that male sex (adjusted odd ratios: 20.03), primiparity (0.19), home delivery (0.32), receiving infant feeding advice (5.90), initiation of breastfeeding within one hour of birth (0.26) and giving colostrum to the baby (2.56) were independently associated with exclusive breastfeeding. Prelacteal feeds were given by almost 35% of mothers.

Conclusion: Prevalence of exclusive breastfeeding was higher than the national figures. However, practices like discarding the colostrum, giving prelacteal feeds, early/late weaning and use of formula feeds are still widely prevalent and need to be addressed.

Keywords: Breastfeeding, Exclusive breastfeeding, Prelacteal feeds, India, Urban.

Citation: IeJSME 2009: 3 (2): 14-18

DOI: https://doi.org/10.56026/imu.3.2.14

Authors: Rashid A K, Teh Swee-Ping, Narayan K A.

ABSTRACT

Background: Circumcision though not mentioned in the Quran is believed to be a compulsory practice among the Muslims. In Malaysia, although there are several methods of circumcision available and traditional circumcision is still popular.

Methods: A cross-sectional survey was carried out in a small fishing village of Kedah to study the methods of circumcision available to the villagers. This was followed with an in-depth interview conducted with ‘Tok Mudim’, a practitioner of traditional method of circumcision.

Results: Forty three of the eligible 71 subjects participated in the study giving the response rate as 60.5%. The most common age for circumcision was 9 years old. Despite private clinics being the most common place of circumcisions, there was an increasing number of boys going to the ‘Tok Mudim’ for circumcision. A Mass Circumcision Ceremony is traditionally practiced. The ‘Tok Mudim’ described the procedure in detail and was of the opinion that the reason traditional method is still popular was because of the fear of injections and impotency among the parents. Most common complication faced by the ‘Tok Mudim’ was bleeding and infection.

Discussion and Conclusion: Till the community shifts entirely to using modern medicine, there is a need to integrate traditional practitioners into the system. Training the ‘Tok Mudim’ to use modern instruments and aseptic techniques should be considered.

Keywords: Male circumcision, rural, Malaysia.

Citation: IeJSME 2009: 3 (2): 19-23

DOI: https://doi.org/10.56026/imu.3.2.19

Authors: Toh Peng YEOW, Mark Kiak Min TAN, Li-Cher LOH, Julia BLITZ.

ABSTRACT

Appreciation of learning styles can be of use to help both educators and students to enhance the effectiveness of an educational experience. It has been noticed that some students at this College are not very good at expressing themselves in either written or spoken English. Our study aimed to identify the student’s learning styles; assess whether there is any correlation between learning style, baseline demographic data and self rated proficiency in English language; and assess their associations with the assessment performance.

A group of third year medical students voluntarily participated in a questionnaire study to provide us with their learning styles, demographic information and self-rated proficiency in English language. This data was compared to the students’ performance in the assessment at the end of their junior clinical rotations.

This cohort of students (60% Malay, 35% Chinese and 5% Indian) who were mostly visual learners, considered themselves proficient in English. Students with predominantly Visual learning styles and those with poorer English, score significantly lower during their clinical long case examinations. These two predictors appear to be independent of each other.

These results may suggest that our current teaching modalities may disadvantage students with predominant visual learning styles. It also suggests that the long case clinical examination may favour those with more verbal learning styles.

Keywords: Clinical performance, English proficiency, Learning styles, Visual learners.

Citation: IeJSME 2010: 4 (1): 7-13

DOI: https://doi.org/10.56026/imu.4.1.7

Authors: S Sulaiha S A, Wee Yun Ling, Lie Joo Chin, Wei-Liang Eow, Muhamad Faiz S, Noris Chien Fook Tan.

ABSTRACT

Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect. Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.

Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.

Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.

Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high incidence of nosocomial infection in our local practice.

Keywords: Effective hand washing, Nosocomial infection, Practice of hand washing.

Citation: IeJSME 2010: 4(2): 18-26

DOI: https://doi.org/10.56026/imu.4.2.18