Authors: Tze Hao Wong, Esha Das Gupta, Ammu K Radhakrishnan, Suk Chyn Gun, Gandhi Chembalingam, Swan Sim Yeap.

ABSTRACT

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population.

Methods: A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD.

Results: Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002).

Conclusions: Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.

Keywords: osteocalcin, bone mineral density, DAS28, rheumatoid arthritis, Malaysia.

Citation: IeJSME 2018 12(1): 4-10

DOI: https://doi.org/10.56026/imu.12.1.4

Authors: Htar Htar Aung, Nilar Shwe, Tin Tin Myint, Tin Moe Nwe.

ABSTRACT

Introduction: It is still a challenge that the dissecting room has a place in learning gross anatomy. Understanding the students’ preference of learning tools is important to devise alternative teaching aids for improvement in learning anatomy. This study was conducted to assess student’s preference of learning tools available in the anatomy laboratory of an integrated curriculum.

Methods: A cross-sectional comparative study was carried out for 4 weeks among 741 medical and dental students of International Islamic University Malaysia (IIUM), Universiti Teknologi MARA (UiTM), University Sabah Malaysia (UMS) and University Malaysia Sarawak (UNIMAS). Pre-tested, semi-structured, self-administrated questionnaires including open-ended questions were distributed. The data were analyzed by using SPSS 17.

Results: Most of the participants were Malays (86%) and female (67%). The students from IIUM, UiTM, UMS and UNIMAS preferred the plastic model in terms of handability and application in examination (OSPE). It was statistically significant (p<0.05). In terms of understanding and information, the students of IIUM, UiTM and UMS
preferred the plastic model while UNIMAS students preferred the prosected wet specimen over the plastic models. In terms of overall preference, students of IIUM and UiTM preferred the plastic model (85.8% and 44.1% respectively). In UNIMAS, their preference for the prosected wet specimen (90.7%) was slightly higher than for the plastic model (87.8%). UMS students preferred both cadaver (51.9%) and plastic model (50%).

Conclusion: Most of the students preferred the plastic model as the best learning tool in studying gross anatomy. This study suggests that plastic model may hold a role in enhancing students’ learning of gross anatomy in an integrated curriculum.

Keywords: Cadaver; learning tool; plastic model; prosected wet specimen; students’ preference.

Citation: IeJSME 2018 12(1): 11-17

DOI: https://doi.org/10.56026/imu.12.1.11

Authors: Sarvesh Seger, Chen Giap Tee, Samin Uddin, Wen Han Sia, Mie Aye Lwin.

ABSTRACT

Introduction: Depression is a debilitating illness and has become a leading cause of disability worldwide. According to the National Health Survey IV, the prevalence of lifetime depression was 2.4% and current depression was 1.8%. In a review article published by the Department of Psychological Medicine, University of Malaya, the prevalence of depression in Malaysia was estimated to be between 8% and 12%. A cross-sectional study carried out in Selangor, Malaysia showed that 10.3% of adults aged 18 and above suffered from depression. Depression carries dire societal and health-related consequences that affect both the individual and the community as a whole, and is potentially a chronic illness with high morbidity, rate of relapse and recurrence. This study was performed to identify the prevalence of depression and factors associated with it.

Method: A cross-sectional study was done on 354 Malaysian adults above the age of 18 residing in the district of Mantin, Malaysia. Non-Malaysians and people with known-depression were excluded. A questionnaire was developed to detect the sociodemographic factors and Patient Health Questionnaire 9 (PHQ-9) was used
to screen for depression.

Results: The proportion of the participants shown to score mild to major depression was 44.4%. Higher prevalence was found in individuals who were males (45.2%), in the age group of 38 years and below (48.3%), Malays (45.5%), having low levels of income (46.0%), having lower levels of education (45.7%), not married (48.1%), a parent (45.3%), having positive family history of depression (60%) and suffering from chronic illnesses (48.4%). Satisfaction with family members was a strong and independent factor associated with depression (OR 3.051, CI 1.445-6.444, p-value 0.002).

Conclusion: The prevalence of depression in the study population of Mantin was high and significantly associated with family satisfaction. Creating awareness regarding depression in this community is recommended. Projects and programmes encouraging individuals to connect with the family should be considered. In addition, policies should be put in place to promote more family time in the community.

Keywords: Depression, prevalence, associated factors, PHQ-9, Malaysia.

Citation: IeJSME 2019 13(1): 4-14

DOI: https://doi.org/10.56026/imu.13.1.4

Authors: Gerald Jian Ming Lee, Sze Mi Tey, Tze Keei Lim, Kar Siang Chew, Rajitha Chamath Wickrama, Malik Goonewardene.

ABSTRACT

Introduction: Inter-observer variations are one of the several limitations in the use of Symphysis-Fundal Height
(SFH) measurements which are frequently used to screen for foetal growth abnormalities prior to ultrasound foetal biometry.

Objectives: The objectives of this study are to measure the interobserver variations of SFH measurements obtained
by Semester 8 medical students of the International Medical University (IMU), Malaysia and to determine whether there is any association between maternal and observer factors and the inter-observer variations.

Method: A cross sectional study was carried out among 77 pairs of the IMU Semester 8 medical students who underwent training in the Obstetrics and Gynaecology (O&G) posting from 26th February to 31st May 2018. The first student in each pair was aware of the patient’s demographics, her gestational age (GA) and her obstetric complications if any, while the second student was blind to all the maternal data. The Limits of Agreement between the two SFH measurements obtained by a pair of students were calculated. The association between the inter observer variations in the SFH measurements obtained by a pair of students and maternal height, weight, GA, parity, body mass index (BMI) and the students’ duration of training in the O&G posting were studied.

Results: The limits of agreement between the two SFH measurements obtained by a pair of students were very wide and ranged from – 6.0 cm to + 5.6 cm. Approximately 34% of the 77 pairs of students had inter-observer variations of SFH within the clinically acceptable limit of – 2cm to +2cm. There was no association between inter-observer variations in SFH and maternal height, weight, GA, parity, body mass index (BMI) and the students’ duration of training in the O&G posting.

Conclusions: There were wide inter-observer variations between the SFH measurements obtained by IMU Semester 8 medical students but the variations were not associated with maternal or observer factors.

Keywords: Inter-observer variations, symphysio-fundal height measurements, medical students, maternal factors, observer factors.

Citation: IeJSME 2019 13(1): 15-25

DOI: https://doi.org/10.56026/imu.13.1.15

Authors: Cheong Lieng Teng, Kean Ghee Lim, Ee Ming Khoo, Chirk Jenn Ng, Lee Yen Chong, Mei Yee Lee, Nawal Aqilah Amir, Jia Ling Voon, Wilson Wei Sheng Chin.

ABSTRACT

Objectives: To evaluate study designs and citation counts of original research published in the Medical Journal of Malaysia (MJM).

Methods: The bibliographic data of the MJM for the period 1980-2016 were retrieved from PubMed and analysed using Endnote bibliographic software. Study designs of original journal articles were analysed according to whether the articles were diagnostic study, prognostic study or clinical trial (collectively known as “evidence papers”). The citation counts of the original articles and case reports for the period 2012-2016 were compared in a sub-study using a case-control design.

Results: A total of 3952 MJM journal items were retrieved from PubMed for the period 1980-2016; of these, 58.9% were original articles and 29.5% were case reports. Among the original articles, 14.6% were “evidence papers”; 2.3% were diagnostic studies, 7.7% were prognostic studies, 4.6% were clinical trials. In the study period 2012-2016, “other types of original articles” had statistically significantly more citations than case reports. However, there is no difference between “evidence papers” and case reports.

Conclusion: Our analysis shows the distribution of the types of articles appearing in the MJM for the period of study and serves as a reference for improving citations counts in the local context.

Keywords: Bibliometrics; Citation count; Medical Journal of Malaysia; Study design.

Citation: IeJSME 2019 13(1): 26-32

DOI: https://doi.org/10.56026/imu.13.1.26

Authors: Helen Thong, Sangeetha Shyam, Ammu Radhakrishnan, Cheong Lieng Teng.

ABSTRACT

Introduction: Serum amylase and adiponectin levels have shown promise as markers of cardio-metabolic diseases.
However, the levels of these markers in saliva and their association with glycaemic management in diabetes mellitus (DM) are not well documented. Therefore, we investigated the correlation of salivary amylase and adiponectin concentrations with measures of glycaemic control in type 2 diabetes mellitus (T2DM) participants.

Methods: We conducted a cross-sectional study involving 80 T2DM participants of Indian and Malay ethnicity. Saliva was collected, and salivary amylase and adiponectin concentrations were analysed. Recent fasting blood sugar and HbA1c of the participants was obtained from their medical records. The correlations of salivary amylase and adiponectin with fasting blood sugar and HbA1c were calculated using Spearman’s correlation.

Results: There was a weak positive correlation between salivary adiponectin and HbA1c (rho = 0.221, p = 0.051). The salivary adiponectin levels was significnalty lower among participants with good glycaemic control (HbA1c ≤ 7.0%) compared to those with poor glycaemic control (HbA1c > 7.0%,) (1.13 (1.75) vs. 2.34 (3.54) ng/ml, p = 0.039).

Conclusion: Salivary adiponectin weakly correlated with HbA1c, while salivary amylase showed no correlation with
the glycaemic parameters studied. Therefore, salivary adiponectin may warrant further investigation as a potential non-invasive biomarker of T2DM.

Keywords: Type 2 diabetes mellitus (T2DM); salivary adiponectin; salivary amylase; haemoglobin A1c (HbA1c).

Citation: IeJSME 2020 14(1): 8-21

DOI: https://doi.org/10.56026/imu.14.1.8

Authors: Swee Geok Lim, Vivian Jeng Tuk Fong.

ABSTRACT

Background: Physical restraint is any measure or technique that prohibits an individual’s body movement. Although physical restraint is one of the most common methods used to ensure patient safety in the intensive care units, its usage is an arguable practice. Involuntary immobilisation of a patient challenges patient’s rights while over usage of physical restraints can lead to possible harm to the patients. Critical care nurses especially should make accurate decisions regarding the use of physical restrains if they are to ensure patient safety.

Objective: The objective of this study was to determine the knowledge, attitude, and practices of critical care nurses on usage of physical restrainer in a private hospital in Klang Valley.

Methods: This was a cross-sectional, quantitative descriptive study using the Physical Restraint Questionnaire (PRQ) to collect data from 103 registered nurses through simple random sampling in the Critical Care Unit of a private hospital.

Results: A total of 103 critical care nurses participated in this study. The nurses had moderate level of knowledge of physical restraint usage, 43.96 ± 4.05 (36 to 53), positive attitude towards the use of physical restraint, 30.47 ± 2.96 (24 to 39) and good practices on usage of physical restrainers, 38.88 ± 2.73 (29 to 43).

Conclusion: Findings revealed that majority of critical nurses have moderate knowledge, positive attitude and satisfactory practices on usage of physical restraint. However, continuous updates on usage of physical restraint and its legal implications are highly recommended to ensure critical care nurses are better informed before deciding to use physical restraint on their patients.

Keywords: Knowledge, attitude, practices, physical restraint, critical care nurses, acute care units.

Citation: IEJSME 2021 15 (1): 5-18

DOI: https://doi.org/10.56026/imu.15.1.5

Authors: Kiranjeet Kaur, Puvessha Jegathisan, Cheryl Tham Sin Yi

ABSTRACT

Introduction
Within the recent years, crisis helpline organizations in Malaysia have been experiencing a surge in calls, and with the current worldwide anxiety caused by Covid-19, these call volumes are expected to rise. Therefore, volunteers who staff these helplines are continuously placing their Professional Quality of Life (ProQoL) at risk due to the ongoing stressors involved in this service. However, it has been previously noted that the utilization of coping strategies may contribute to the enhancement of a volunteer’s ProQoL. Hence, this study focuses on examining the relationship between three types of coping strategies and the positive aspect of ProQoL, which is compassion satisfaction.

Methods
Through the use of a cross-sectional survey design, a total of 118 crisis helpline volunteers within the Klang Valley responded to a self-report online questionnaire consisting of the Coping Strategy Indicator (CSI) and the Professional Quality of Life Scale Version 5. Pearson’s correlation analysis and multiple regression analysis were used to analyse the relationship between the variables.

Results
Problem-solving coping and social support coping demonstrated a positive correlation with compassion satisfaction (r = .677, p < .001) (r = .261, p = .002), whereas avoidance coping demonstrated a negative correlation (r = -.572, p < .001). Correspondingly, problem-solving coping was revealed to be the best predictor towards compassion satisfaction through the regression analysis.

Conclusion
The findings of this study suggests that utilizing adaptive coping mechanisms may produce a more favourable outcome among crisis helpline volunteers as it correlates to a higher satisfaction level. Consequently, organizations would be able to positively benefit from a high satisfaction level within their volunteers as it would reinforce their motivation and efforts to continue engaging in this noble service.

Keywords: coping strategies, professional quality of life, compassion satisfaction, crisis helpline.

Citation: IEJSME 2021 15 (1): 19-27

DOI: https://doi.org/10.56026/imu.15.1.19

Authors: Kian Hock Tan, Rachel Ley Tan, Jolene Sze Tien Shu, Han Yao Foong, Siok Joan Siek, Kwee Choy Koh, Cheong Lieng Teng.

ABSTRACT

Background: Social media is a common channel for communication, information and education. However, it is also a potential forum where lapses of professionalism may occur. In this study we aimed to elicit medical students’ perspective on social media practices and their perceived implications of social media posts.

Methods: We conducted a cross-sectional study of Semesters 1 and 9 medical students from the International Medical University (IMU). A score was created consisting of the sum of the Likert scale in the 10-item social media practices questionnaire. Categorical variables were compared using chi-square test, while continuous variables that were not normally distributed were compared using Mann-Whitney U test. Statistical significance was set at p<0.05.

Results: Out of 118 respondents (61% females), 54.2% of them recalled previous instructions regarding the use of social media and 55.1% of them were familiar with the IMU Social Media Guidelines. In general, respondents showed high level of awareness of inappropriate social medial practices, with statistically better awareness among Semester 1 students. Students who reported familiarity with IMU Social Media Guidelines were more aware of inappropriate social media practices. Most respondents were aware of the potential adverse impact of social media posts.

Conclusion: IMU students who participated in our survey generally had a good grasp of what constitutes inappropriate behaviour on social media and its potential future impact. Lower level of awareness of inappropriate social media practices among the Semester 9 students points to the need for periodic reminders of IMU Social Media Guidelines.

Keywords: Medical students, social media, professionalism and medical ethics.

Citation: IEJSME 2021 15 (1): 28-39

DOI: https://doi.org/10.56026/imu.15.1.28

Authors: Swee Geok Lim, Ching Nguk Ngieng, Xie Yen Tan.

ABSTRACT
Background: End of life (EOL) care is a holistic approach for patients and their families, that involves physical, emotional, spiritual, and social needs. There are approximately 80,000 Malaysians requiring EOL care annually but only 2,000 patients have access to the service. Despite an increasing demand for EOL care in Malaysia, many healthcare professionals are still unfamiliar and inadequately trained in dealing with the EOL issue. The purpose of study is to evaluate the Diploma in Nursing students’ level of knowledge and attitude towards EOL care.

Method: A cross-sectional descriptive study on 127 nursing students from a private nursing college in Penang, through simple random sampling was conducted. The Palliative Care Quiz for Nursing was used to determine the knowledge of EOL care, while Frommelt Attitude Towards Care of Dying Patients-Form B, was used to measure attitude towards EOL care.

Result: Overall, the participants had poor knowledge towards EOL care with mean overall score of 8.18 ± 2.14. The mean overall score for attitude towards EOL care was 117.76 ± 11.12, implying a positive attitude towards EOL care. There was a significant difference in the level of knowledge (t = 5.250, p < 0.001) and attitude (t = 6.184, p < 0.001) according to the years of study.

Conclusion: The student nurses had poor level of knowledge on EOL but positive attitude towards EOL care. Adding an additional module on EOL alone is inadequate; instead emphasis on its relevancy and understanding on how it can be used to improve patient care is of far more importance.

Citation: IEJSME 2020 14 (3): 7-15

DOI: https://doi.org/10.56026/imu.14.3.7