Assessing Students – Clinical Competence Versus Performance

Posted Posted in Review Articles

Author: John Ruedy

ABSTRACT

The recent elaboration of the range of physician competencies upon which the quality of health care is dependent has fostered the development of a variety of methods of assessing medical student competencies and performance. Such assessments are essential in providing feedback to students to guide their learning and to faculty on the success of the curriculum in achieving competency outcomes. In addition they provide evidence that students have achieved minimum requirements for progressing. Well-designed Observed Structured Clinical Examinations (OSCEs), Mini-Clinical Examinations (Mini-CEXs) and some forms of Multi-Source Feedback (MSF) can meet acceptable standards of validity and reliability and are feasible. Competency assessments are limited in predicting how a student will actually act in the work situation particularly in humanistic skills. More emphasis needs to be placed on student performance, in such competencies as communication and professionalism, in a variety of settings by a number of observers.

Keywords: assessment, evaluation, clinical competence, performance, multi-source feedback.

Citation: IeJSME 2007: 1 (1): 15-21

The Changing Roles Of Pharmacists In Society

Posted Posted in Review Articles

Authors: Stephen Arthur Hudson, John Jackson Mc Anaw, Barbara Julienne Johnson.

ABSTRACT

A clinical role for pharmacists has developed in response to the societal need to improve the use of medicines. Clinical role development has been led by initiatives in the hospital sector which have enabled Schools of Pharmacy to make shifts in the pre-graduate education of pharmacists. The increasing complexity in the management of drug therapy has given pharmacists clear roles that integrate within the healthcare team. The history is one in which the development of changing roles of pharmacists is an example of progress in healthcare delivery creating the need for revision of the curriculum for a whole profession.

Milestones in the changing roles and in the preparation of pharmacists for those roles have been; Establishment of clinical pharmacy in the US hospitals and the doctorate (PharmD) as the professional entry qualification; postgraduate clinical pharmacy education in UK and elsewhere, notably Asia and Australasia; hospital pharmacist specialisation across the wide range of medical specialties; the clinical teaching of pharmacists; the concept of ‘pharmaceutical care’ as a factor in public health; changes in Schools of Pharmacy – with professors of pharmacy practice and a shift to patient-centred teaching.

Future evolution of pharmacist roles will follow the wider use of quality systems to address errors in prescribing and drug administration; the automation of systems of drug prescribing and administration and improved documentation of care; widening of prescribing roles; increased patient education and higher patient expectations; patient-centred research in Schools of pharmacy; development of primary care and improved accessibility to pharmaceutical advice; integration of pharmacists’ public health roles in strategies to address prevention and management of disease.

Keywords: clinical pharmacy, pharmacy education, pharmaceutical care, chronic disease management, drug therapy problems, public health.

Citation: IeJSME 2007: 1 (1): 22-34

Local Repeatedly-Used Deep Frying Oils Are Generally Safe

Posted Posted in Review Articles

Author: Tony Ng Kock Wai

ABSTRACT

A review of the literature indicates that food scientists and health authorities in several countries, especially member countries of the European Union, are still very concerned about the potential health hazards of oxidized products and lipid polymers formed in repeatedly-used deep frying oils. During the frying process at temperatures of 170° – 200°C, steam formed from moisture in the food being fried help volatile products rise to the surface of the frying medium and into the kitchen atmosphere, imparting a mixture of fried-flavours and off-flavours. The non-volatile compounds formed, however, gradually build up in the oil as it is being repeatedly-used for food frying operations. These non-volatiles, primarily “polar compounds” (PC) and to a lesser extent lipid polymers, get absorbed into fried foods and eventually end up in our body system. Available local data suggests that deep-frying oil samples obtained from food hawkers and those produced under simulated deep-frying conditions in the laboratory, are generally safe as they contain PC within safe limits and rarely exceed the upper limit (UL) of 25%. This contrasts with the situation in some European countries where a very high proportion of frying oil samples collected from fast-food restaurants were reported to contain PC exceeding this UL. Appropriately, promotion of Hazard Analysis and Critical Control Points (HACCP) certification and gazetting of food regulations to limit the PC content in frying oils have been introduced in these countries to protect the health of consumers. Meanwhile, simple gadgets/test kits are available commercially to monitor the quality of the frying oil. This would greatly assist kitchen supervisors at restaurants and franchised fried-food outlets to know when best to change a batch of frying oil before the ULs of frying oil quality are breached.

Keywords: Frying oils, Polar compounds, Safety.

Citation: IeJSME 2007: 1 (2): 55-60

Understanding the Decision-Delivery Interval in Cesarean Births

Posted Posted in Review Articles

Authors: Naseem Rashid, Sivalingam Nalliah.

ABSTRACT

Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.

Keywords: Cesarean delivery, Decision-delivery interval, Indications for emergency cesarean delivery, Perinatal asphyxia, Birth asphyxia.

Citation: IeJSME 2007: 1 (2): 61-68

Pharmacogenomics In Drug Therapy And Interaction: The Role Of Cytochrome P450

Posted Posted in Review Articles

Authors: Chin-Eng Ong, Yan Pan, Kai-Hung Tiong, Beow-Chin Yiap, Eng-Lai Tan, Peter Pook, Joon-Wah Mak.

ABSTRACT

Pharmacogenomics (or pharmacogenetics), the study of the effects of genetic differences on a person’s response to drugs, can help in optimizing drug efficacy and minimizing adverse drug reactions. Interperson difference in drug metabolism is one of the important consequences of such genetic variation. This variation is determined in part by mutations in cytochrome P450 enzymes (CYPs). IMU is part of a major collaborative research project in the area of phamacogenetics and drug metabolism. Working together with USM and UiTM, our group has, since 2000, generated useful population database on genetic polymorphism of various CYP isoforms. We have successfully genotyped three major ethnic groups, Malay, Indian and Chinese for their allelic frequency of important isoforms. These include CYP2D6, CYP2C9, CYP2C8 and CYP2A6. Data generated so far collectively have contributed to our effort in mapping and constructing genomic database for Malaysian population.

Since early 2002, our research has been focusing on developing in vitro methods in studying the functional consequences of genetic polymorphism of CYP enzymes. Using site-directed mutagenesis, CYP mutants, carrying nucleotide changes as reported in known alleles in human populations, were generated and expressed in E. coli system, and the expressed recombinant proteins were characterized using enzyme assays to determine the functional consequences of mutations. We have established a series of HPLC (high performance liquid chromatography)-based and fluorescence-based assays to investigate CYP activities. Assays that have been developed include tolbutamide methylhydroxylase, paclitaxel 6a-hydroxylase, dextromethorphan O-demethylation, testosterone 6b-hydroxylation and coumarin 7-hydroxylase assays. These assays serve as activity markers allowing comparison of catalytic activities of mutant proteins generated. Another focus of our work is to use the developed assays as a screening tool to investigate drug-herb interactions. This was achieved by co-incubation of herbal extracts and active constituents with the probe substrates in the assays followed by characterization of the kinetic behaviors of the enzymes involved using various pharmacokinetic parameters such as Km, Vmax, IC50 and Ki. This work is currently carried out with collaboration from the Institute for Medical Research (IMR) and is supported by MOSTI’s eScienceFund under RM9. It is envisaged that this screening work will give us insights on the potential of the commonly used herbs to cause pharmacokinetic interactions with other drug substrates, and allow us to elucidate the mechanisms involved in the interactions.

Keywords: Pharmacogenomics, Pharmacogenetics, Drug Interaction, Drug Therapy, Cytochromes P450.

Citation: IeJSME 2008: 2 (Suppl 1): S6-S10

Environmental Health And Building Related Illnesses

Posted Posted in Review Articles

Authors: Stephen Ambu, Wan-Loy Chu, Joon-Wah Mak, Shew-Fung Wong, Li-Li Chan, Siew-Tung Wong.

ABSTRACT

Malaysia has good environmental laws to protect the outdoor environment and public health. However there are no laws governing indoor air quality (IAQ) and the knowledge among the public about its importance is also lacking. Environmental professionals think it is not a priority and this influences the policy decisions in the country. Therefore there is a need to create awareness by way of research, education and other promotional activities. What is much needed at this time is the establishment of standards for the conduct of risk assessment studies. To establish standards we need reliable data which can be used to develop appropriate guidelines for the purpose of mitigation and adaptation programmes. IAQ can have significant influence on health resulting in drop in productivity and economy of a country. It has been estimated that in the US, building related illnesses (BRI) symptoms have a relationship with decrease (3 to 5%) in work performance in an affected population resulting in an annual loss of US$60 billion in revenue. However, based on efficient management programmes they have also projected that the potential annual savings can be in the region of US$10 to 30 billion. This establishes that fact that good management programmes based on efficient guidelines is of economic value to a country and wellbeing of the population. The IMU has embarked on a research programme to collect the much-needed data for the framing of a good IAQ guideline for Malaysia.

Keywords: Indoor air quality, health.

Citation: IeJSME 2008: 2 (Suppl 1): S11-S18

Initiatives for Medical Education Research at the International Medical University

Posted Posted in Review Articles

Authors: Ramesh Chandra Jutti, Vishna Devi Nadarajah, Victor Lim.

ABSTRACT

Medical Education research is a relatively new field but one that is progressing rapidly worldwide. This article is an attempt to take stock of the current status of Medical Education research in International Medical University and to explore the various factors that have influenced its direction. It also shares some of the initiatives that have been instituted or intended to be instituted at our university.

Keywords: Medical education, research.

Citation: IeJSME 2008: 2 (Suppl 1): S19-S20

Research On Bioactive Molecules: Achievements And The Way Forward

Posted Posted in Review Articles

Authors: Wan-Loy Chu, Ammu Kutty Radhakrishnan.

ABSTRACT

Research on bioactive molecules is one of the thrust areas of research at the International Medical University (IMU). The bioactive molecules that have attracted the interest of IMU researchers include tocotrienol, astaxanthin, zingerone, apigenin, carrageenan and phycocyanin. There are also projects which focus on the screening of extracts from local plants such as Elephantopus mollis, Morinda citrifolia, Pereskia bleo, Euphorbia hirta, Zinger officinale, Mangifera indica and Nephelium lappaceum and algae such as Spirulina and Gracilaria. Characterisation of the toxin from Bacillus thuringiensis is another area of active research at IMU. The compounds and extracts from the various organisms are screened for anticancer, antioxidative, antiviral and immuno-modulating activity. There are also studies on the production of recombinant molecules, especially monoclonal antibodies for the detection of house dust mites, Salmonella typhi and Candida. The pool of faculty with diverse expertise and the active collaboration with public universities and institutions have enhanced the progress of bioactive research at IMU. With the current postgraduate and Bachelor of Medical Science (B. MSc.) programme and the introduction of new programmes in health sciences, there are good opportunities for training of students in the research on bioactive molecules. The future research direction should focus on the mechanisms of action of the bioactive molecules using new approaches such as ‘omic’ technologies and in silico modelling.

Keywords: Algae, anticancer, antioxidant, antiviral, bioactive compounds, recombinant molecules, tocotrienol.

Citation: IeJSME 2008: 2 (Suppl 1): S21-S24

Clinical Research In The International Medical University

Posted Posted in Review Articles

Author: Sivalingam Nalliah

ABSTRACT

Clinical research refers to any field of research involving human subjects. Clinicians as researchers are well placed in contributing to research as they have access to human subjects and are able to apply research results for better patient outcome. The need for clinician-scientists as a dedicated breed is hence implied. Clinical research has low priority in the agenda of academic clinicians for various reasons. Strategies to overcome such a malady include training in research methodology and creating a permissive environment for the conduct of research. The IMU has introduced several measures to enhance clinical research and has a vibrant postgraduate program. The BMedSc programme has seen an increase in MBBS students taking this degree. Research is part of the curriculum before the Semester 7 examinations. Clinicians have been increasingly seen to be involved in research. The enhancement of clinical research through encouraging formal clinical research training and development of the MBBS-PhD programs could further enhance clinical research at the IMU. Attention to logistic constraints, improvement in collaboration with the CRC-MOH and other agencies and the close working relationship with scientists will propel clinical research to higher levels.

Keywords: Clinical research, clinical methodology training, clinician-scientist, collaboration with scientists.

Citation: IeJSME 2008: 2 (Suppl 1): S25-S34