Authors: Wilkinson Yoong Jian Tan, Jo Wearn Yeap, Sharifah Sulaiha Syed Aznal.

ABSTRACT

Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections.

Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979).

Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis.

Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.

Keywords: Thrombophlebitis, Catheter, Catheter-Related Infections, Intravenous Infusions, Patient Care.

Citation: IeJSME 2012 : 6(1) 24-30

DOI: https://doi.org/10.56026/imu.6.1.24

Authors: Ammu Kutty Radhakrishnan, Nagarajah Lee, Mei-Ling Young.

ABSTRACT

Background: Medical schools have long been concerned with establishing a suitable process of admission. The criteria used to select students have traditionally focussed on high academic achievement.

Method: The International Medical University (IMU) accepts students from a wide range of pre-university entry qualifications for admission into the medical programme. The criteria for the various pre-university entry qualifications used by the IMU were agreed and accepted by the IMU Academic Council (AC), which consist of deans of the IMU’s partner medical schools (PMS). In this study, the various entry qualifications were first grouped into five categories based on the educational pedagogy. Then, this was aligned with the entry qualification data of all students who had been admitted into the IMU medical programme for the period of December 1993 to March 2000. During this period 1,281 students were enrolled into the IMU medical programme. The relationship between the five groups of pre-university entry qualifications and the students’ academic achievement in three end-of-semester (EOS) examinations namely EOS 1, EOS 3, and EOS 5 were analysed.

Results: Students with better grades in their pre-university examinations showed better performance in their EOS examinations, regardless of the subjects that they took at the pre-university level. Cluster analysis revealed that students who came in with certain pre-university qualifications generally performed poorly than the more conventional qualifications. However, after their first year in medical school, there were no significant differences in the clustering of the students.

Conclusion: Students with better grades in their pre-university examinations showed better performance in their EOS examinations, regardless of the science subjects that they took at the pre-university level.

Keywords: pre-university, entry qualifications, examinations, criteria for entry.

Citation: IeJSME 2012 6(2): 10-17

DOI: https://doi.org/10.56026/imu.6.2.10

Authors: Faridah Hanim Zam Zam, Nazimah Idris, Tham Seng Woh.

ABSTRACT

Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis.

Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control.

Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess.

Conclusion: Certain second stage fetal heart rate patterns were found to be associated with neonatal acidosis.

Keywords: fetal heart rate patterns; second stage of labour; neonatal acidosis.

Citation: IeJSME 2012 6(2): 18-23

DOI: https://doi.org/10.56026/imu.6.2.18

Authors: Donald Koh Fook Chen, Joon Wah Mak, Soo Shen Ooi, Kok Fee Mak, Kwai Hoe Chong.

ABSTRACT

Background: A number of Traditional Chinese Medicine (TCM) preparations are being used for the treatment of diabetes mellitus. Some components of these preparations have biochemical effects other than those of lowering blood glucose and indeed have been used for other medical indications in traditional practice. The primary objective of the study was to determine the effect of the oral mixture of Traditional Chinese Medicine for diabetes (TCM-D™ complex) on blood glucose level and the biochemical changes if any, on the liver (ALT, AST, gamma-GT, albumin, globulin) and renal (blood creatinine, urea) functions in normal mice. The oral mixture is an aqueous extract of four well-known traditional Chinese medicinal herbs and consists of Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer in the proportion of 36%, 28%, 18%, and 18% respectively of the dry weight. These herbs have been shown to have blood glucose lowering activity and have been used for other traditional medicinal purposes. The safety of the combination was evaluated in the present study.

Methods: Experimental Balb/c mice were treated orally via gastric tube with the extract at daily doses equivalent to 1 and 10 times the recommended human dose for 8 weeks. Blood glucose and other biochemical profiles were monitored at pre-treatment and monthly post-treatment until killed.

Results: When compared to pre-treatment levels, the blood glucose levels were significantly lower in treated animals compared to those in the control group. At the recommended TCM-D™ dose the levels in treated animals were significantly lower than that of control animals and at pre-treatment. When compared with pre-treatment, the glucose levels were lowest at Week 8 of treatment, the mean levels being 111.23%, 83.32% and 70.33% in control, and in animals given 1 x and 10 x the recommended TCM-D™ dosage respectively. The blood glucose lowering effect was also associated with a significant weight loss in treated animals. There were transient increases in AST and ALT levels but these reverted to normal at Week 8 of treatment. The levels of bilirubin, g-GT, albumin, creatinine and blood urea were also not significantly different at Week 8 from pre-treatment levels in all groups.

Conclusion: Even at 10 times the dosage recommended for humans, TCM-D™ did not affect the liver and renal functions of treated animals. Treated and control animals remained healthy and normal throughout the period of observation.

Keywords: Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer, blood glucose lowering, weight loss, biochemical changes.

Citation: IeJSME 2012 6(2): 24-31

DOI: https://doi.org/10.56026/imu.6.2.24

Authors: Keat Seong Teo, Cheong Wooi Cheah, Joon Wah Mak.

ABSTRACT

Background: Sensitisation to house dust mite (HDM) has been regarded as a major risk factor for development of asthma. This study was carried out to investigate the profiles of HDM sensitisation among Malaysian children with asthma.

Material and Methods: The association between HDM sensitisation and control and severity of asthma was investigated. The salivary HDM specific IgE levels were quantified in different grades of control and severity of asthma in 125 unselected asthmatic children aged 5-12 years old attending the asthma follow-up clinic in Hospital Tuanku Ja’afar Seremban. An additional 29 non-asthmatic patients were selected as control. The skin prick test to assess sensitisation to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was performed on all the participants. A questionnaire regarding the control and severity of asthmatic symptoms of the subject was administered. Saliva was collected by voluntary spitting and ELISA was used to quantify the IgE specific to HDM antigen.

Results: There was a significant association between sensitisation to DP and DF and the control of asthma. The association between DP sensitisation and severity of asthma just failed to reach a significant level although there is a clear trend for this. Significant association was found between DF sensitisation and severity. The HDM specific IgE in the saliva was significantly higher in asthmatic patients compared to non-asthmatic patients. There was no significant difference between the specific IgE levels in patients with different severity status of asthma.

Conclusion: Salivary IgE levels may not be an appropriate indicator of the patients’ asthmatic condition in this study. However, it can be concluded that there is significant association between the sensitisation of HDM and the control and severity of asthma.

Keywords: Dermatophagoides pteronyssinus, Dermatophagoides farina, childhood asthma, house dust mite specific-salivary IgE.

Citation: IeJSME 2015 9(2): 3-12

DOI: https://doi.org/10.56026/imu.9.2.3

Authors: Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof, Pei Chiek Teh, Kwee Choy Koh.

ABSTRACT

Background: Misinterpretation of abbreviations by healthcare workers has been reported to compromise patient safety. Medical students are future doctors. We explored how early medical students acquired the practice of using abbreviations, and their ability to interpret commonly used abbreviations in medical practice.

Method: Eighty junior and 74 senior medical students were surveyed using a self-administered questionnaire designed to capture demographic data; frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of mishaps due to misinterpretation; and the ability of students to correctly interpret commonly used abbreviations. Comparisons were made between senior and junior medical students.

Results: Abbreviation use was highly prevalent among junior and senior medical students. They acquired the habit mainly from the clinical notes of doctors in the hospital. They used abbreviations mainly to save time, space and avoid writing in full sentences. The students experienced difficulties, frustrations and often resorted to guesswork when interpreting abbreviations; with junior students experiencing these more than senior students. The latter were better at interpreting standard and non-standard abbreviations. Nevertheless, the students felt the use of abbreviations was necessary and acceptable. Only a few students reported encountering mishaps in patient management as a result of misinterpretation of abbreviations.

Conclusion: Medical students acquired the habit of using abbreviations early in their training. Senior students knew more and correctly interpreted more standard and non-standard abbreviations compared to junior students. Medical students should be taught to use standard abbreviations only.

Keywords: Abbreviations, medical students, medical practice, medical errors, patient safety.

Citation: IeJSME 2015 9(2): 13-21

DOI: https://doi.org/10.56026/imu.9.2.13

Authors: Kavana N J, Lim L H S, Ambu S.

ABSTRACT

Background: The present study describes the morphology of sparganum (larva) of the Malaysian Spirometra spp. collected from naturally infected frogs (Rana cancrivora) from rice fields in Tanjung Karang, Malaysia.

Materials and Methods: Spargana of Spirometra spp. collected from naturally infected frogs (Rana cancrivora) were used for the morphological studies. Stretched on a metal ruler, measurements of the worm were recorded. Specimens were stained in Alum-carmine.

Results: The length of the body ranged from 11-50 mm and the width ranged from 0.5-1.5 mm. Specimens stained with Alum-carmine showed ridges (formation of segments) on the surface of the body, and no sexual organs in the body.

Conclusion: The Malaysian Spirometra spp. are similar in measurement and morphology to Spirometra erinacei but further studies are required for confirmation.

Keywords: Spirometra, spargana, scolex, body, morphology.

Citation: IeJSME 2015 9(2): 22-24

DOI: https://doi.org/10.56026/imu.9.2.22

Authors: Thiruselvi Subramaniam, Rosalind Chi Neo Loo.

ABSTRACT

Introduction: Standard precautions in health care is the essence of medical practice encompassing the safety of patients and health care workers including  medical students. Barriers to the proper use of personal protective equipment (PPE) exist across the world but identification of areas of weaknesses and appropriate remedies will reduce them. This study assesses knowledge and use of PPE among fourth year students after a period of educational interventions.

Objective: To evaluate appropriate use, awareness and knowledge about PPE among fourth year students after interventions.

Method: A cross-sectional study where forty year 4 students (Group B) were randomly observed and later asked to answer a questionnaire. Students had undergone interventions to improve PPE use, which included lectures and video sessions during each posting. Results were compared with a previous group (Group A). Chi-square test or Fisher’s exact test was used to analyse the data.

Results: There was statistically significant improvement in the use of PPE like wearing and removing mask during invasive procedures (p < 0.001) and hand-washing before and after a non- invasive task (p < 0.001). Comparison of Groups A and B on the results of the questionnaire for ‘Questions in which more than 10% students answered incorrectly’, showed that there was improvement in Group B in all the questions, some being statistically significant with p value=0.01.

Conclusion: An overall improvement in the use of the PPE and knowledge was noted. Sometimes, students’ attitude and personality may be a challenge and these students may defy changes, but this can be overcome if the strategies are embedded in the curriculum and taught from as early as the first semester.

Keywords: Personal protective equipment (PPE), standard practice, patient safety, attitudes, medical students.

Citation: IeJSME 2015 9(2): 25-31

DOI: https://doi.org/10.56026/imu.9.2.25

Authors: Kean Ghee Lim, Shu Whey Chuah, Michelle Ee Shan Too, Zheng Guo Wong, Ashwin Murugesan, Syed Ameer Bin Syed Azman.

ABSTRACT

Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.

Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.

Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.

Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.

Keywords: Bekam, cupping, chronic pain, analgesic use, pain score.

Citation: IeJSME 2015 9(2): 32-36

DOI: https://doi.org/10.56026/imu.9.2.32

Authors: Makmor Tumin, Khaled Tafran, NurulHuda Mohd Satar.

ABSTRACT

Background: Most countries around the world have experienced a shortage in organs needed for transplantation. Organ donation performance is widely attributed to two important factors: the legislation and the role of the family. Thus, this literature review aims to examine the willingness of people for organ donation while highlighting the importance of having a presumed consent system.

Methodology: In this study, we explored many papers of which 10 articles were studied to gain conclusive understanding of the two factors and their interactions.

Results: Our analysis of literature regarding the legislation and family response showed that the presumed consent system for organ donation accounted for 21 – 30% higher organ donation rates than the informed consent system. We also found a gap between the willingness of people to donate their own and their relatives’ organs. The ratio of people willing to donate their organs after death was estimated to be 10 – 12% higher than the ratio of those willing to donate their relatives’ organs. Furthermore, the study revealed the  importance of a presumed consent system in raising the willingness of the people and their relatives for donation, but that did not eliminate the gap.

Conclusion: Countries seeking to overcome organ shortage and increase organ donation rates by moving towards  the presumed consent system should consider the importance of providing families with proper information about this system. The fact that a gap between the willingness of the people to donate their own as well as their deceased relatives’ organs exists, has to be conveyed to the governments, which will be helpful in optimising organ donation rates.

Keywords: Family, informed consent, organ donation, presumed consent, public view.

Citation: IeJSME 2015 9(3): 20-26

DOI: https://doi.org/10.56026/imu.9.3.20