Category: Review Articles

Authors: Kathiravan Chinniah, Sivalingam Nalliah.

ABSTRACT

Outcome and competency-based undergraduate and graduate medical education is the desired standard embraced by many medical educationists worldwide. Reflective capacity is an integral component of that strategy and reflective writing has shown tremendous potential as a delivery tool. But there are various challenges in the implementation of the initiative. Efficacy as a delivery tool, achievement of pedagogical outcomes, reliability issues, challenges in assessment outcomes/tools, and whether it can be taught and learnt, need to be addressed. Many questions are still not satisfactorily answered, and this review attempts to offer some perspective on the issues.

Keywords: Reflective writing, outcome-based education, reflective capacity.

Citation: IeJSME 2012 : 6(1) 15-20

DOI: https://doi.org/10.56026/imu.6.1.15

Authors: Tony Kock Wai Ng, Sivalingam Nalliah, Azlinda Hamid, Siew Rong Wong, Sim Ling Chee, Cheryl Andrea Augustine.

ABSTRACT

This paper reviews available reports on the omega-6 (linoleic acid, LA) and omega-3 fatty acid [alpha-linolenic acid (ALA) + eicosapentaenoic acid (EPA) + docosahexaenoic acid) intakes amongst Malaysians against Malaysian Recommended Nutrient Intakes (RNI), focussing particularly on pregnant and lactating women because of the availability of data for these latter vulnerable groups. Overall, the omega-6 and omega-3 fatty acid nutrition amongst Malaysians are poor and far from desirable. The nutritional situation regarding these long-chain polyunsaturated fatty acids (LCPUFA) amongst Malaysian pregnant and lactating women is alarming and warrants urgent attention in nutrition promotion activities/counselling. Daily consumption of LA by these women and other Malaysians studied ranged from 3.69 – 5.61 % kcal with 38-60% of individuals not meeting their RNIs. Daily intakes of omega-3 fatty acids faired worse, averaging 0.21-0.33% kcal with as high as 92% of subjects in one study not meeting their RNIs. The omega-6 to omega-3 fatty acid ratios obtained in the studies reviewed are about 20:1, which is way above the World Health Organisation-recommended ratio of 5-10:1. Dietary sources of these omega- fatty acids in the subjects studied are chicken, fish and milk. Since local foods are not particularly rich in LCPUFA such as EPA and DHA, the options to improve EPA/DHA nutrition amongst Malaysians are the greater consumption of omega-3 enriched foods and in the case of pregnant and lactating women, LCPUFA supplementation may warrant serious consideration.

Keywords: Omega-6 and omega-3 fatty acids, Malaysians intake.

Citation: IeJSME 2012 6(2): 4-9

DOI: https://doi.org/10.56026/imu.6.2.4

Authors: Kamil Jurowski, Anna Jurowska, Małgorzata Krzeczkowska.

ABSTRACT

Mnemonic devices can be defined as learning strategies which can often enhance the learning process and later the recall of information. On the other hand, mnemonic systems are special techniques or strategies consciously used to improve memory, they help employ information already stored in long-term memory in order to make memorisation an easier task. There is no doubt that mnemonic techniques are one of the most important methods and methodologies used in education. However, nowadays these methods seem to be unremembered and seldom used by teachers or students. There is a deficit in the actual reviews on this subject. In this article we review mnemonic methods from the point of view of teaching and learning science subjects. This article is the first work in literature that refers to and emphasises various and complex aspects of mnemonic devices applications in didactic practice like science learning and teaching, helping students with disabilities and behaviour problems and second language acquisition.

Keywords: Mnemonic devices, methods, students with disabilities, behaviour problems, second language.

Citation: IeJSME 2015 9(3): 4-9

DOI: https://doi.org/10.56026/imu.9.3.4

Authors: Davendralingam Sinniah, Erwin Jiayuan Khoo.

ABSTRACT

The sale of tobacco-based cigarettes has declined in western countries, and ‘Big Tobacco’ is trying to make up the deficit in profits from the developing world. The recent introduction of e-cigarette, in which they have invested both their hopes and their finances, has been a boon to them as it serves to confuse smokers and non-smokers about the real issues relating to the toxicity, dangers, and the promotion of nicotine addiction especially among youths who have not previously smoked cigarettes. E-cigarettes cause inflammation and damage to epithelial cells in human airways and increased risk of infection. E-cigarette vapour contains more carcinogens like formaldehyde and acetaldehyde compared to a regular cigarette. Long-term vaping is associated with an incremental lifetime cancer risk. E-cigarettes are neither safe nor effective in helping smokers quit; there is enough evidence to caution children, adolescents, pregnant women, and women of reproductive age about e-cigarette’s potential for long term consequences to foetal and adolescent brain development that sub-serve emotional and cognitive functions. The nicotine effects that cause modification of late CNS development constitute a hazard of adolescent nicotine use. The American Heart Association (AHA), Food and Drug Administration (FDA), World Health Organisation (WHO) and two-thirds of the major nations in the world discourage the promotion of e-cigarettes as an alternative to proven nicotine-addiction treatments. Doctors, health care workers, and medical students should be armed with the facts about e-cigarettes, its dangers, and the legal status concerning its use, in order to be able to offer proper counselling to patients and adolescents, in particular, with special reference to the Malaysian context.

Keywords: E-cigarettes, nicotine addiction, cancer risk, brain development consequence, legislation.

Citation: IeJSME 2015 9(3): 10-19

DOI: https://doi.org/10.56026/imu.9.3.10

Author: Thor Willy Ruud Hansen

ABSTRACT

Autonomy implies the right of a competent patient to make decisions about their own health care. To exercise autonomy a patient must receive an explanation of his/her condition. True autonomy presumes intellectual understanding, the ability to translate theoretical ideas into real-life concepts, and emotional connectedness to the situation.

Children may not be able to understand or process information about treatment choices. Therefore, responsibility for decision-making is vested in the parents. In Norwegian law, this lasts until the child is 12 years old, though the child must be informed and involved commensurate with intellect and maturity. From the ages of 12 until 16, the youngster should increasingly be heard and involved, and from the age of 16 years a youngster is considered medico-legally competent.

Parents who face serious illness in a child are in a life crisis. Yet in spite of this, decision-making competence is often assumed. Decisions with life-or-death or lifetime implications will profoundly influence the life of the family. The best interest of the sick child may not necessarily be compatible with the needs of the family as a unit. As medical caregivers we should be cautious about assuming that our insight into such family realities is adequate. We must sensitively, yet critically, consider decision-making competence, while at the same time supporting the parents’ efforts to cope and make the best decisions possible. However, we must never lose sight of the fact that our primary responsibility is towards the sick child.

Keywords: Bioethics; Autonomy; Children and adolescents; Decision-making competence; Best interest; Parental authority; Emancipation of children.

Citation: IeJSME 2016 10(1): 3-9

DOI: https://doi.org/10.56026/imu.10.1.3

Authors: Chandramani Thuraisingham, Sivalingam Nalliah.

ABSTRACT

A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering symptoms which are not apparent in the conventional interview and contributes to a much broader perspective of illness and health.

The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society.

Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient- centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy.

NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.

Keywords: Narrative medicine, curriculum, patientcentredness, empathy, medical students.

Citation: IeJSME 2017 11(2): 4-13

DOI: https://doi.org/10.56026/imu.11.2.4

Authors: Kavitha Nagandla, Sharifah Sulaiha, Sivalingam Nalliah, Norfadzilah Mohd Yusof.

ABSTRACT

Neuroendocrine carcinoma of the female reproductive tract are a heterogeneous group of rare neoplasms posing both diagnostic and therapeutic challenges. The recent classification by WHO includes neuroendocrine carcinomas (NECs) and neuroendocrine tumours (NETs). NECs are the poorly differentiated small cell carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), while well-differentiated NETs include typical carcinoids (TC) and atypical carcinoids (AC). Majority of these tumours have an aggressive clinical course and published data is supportive of multi-modal therapeutic strategies. Etoposide/platinum based chemotherapy is commonly advocated. Histopathological categorisation and diagnosis are paramount to guide therapy. Well-differentiated carcinoid and atypical carcinoid tumours should be managed similar to gastroenteropancreatic neuroendocrine tumours. This review discusses the current classification, clinicpathologic characteristics and advances in the diagnostic evaluation and the treatment options of neuroendocrine carcinoma of the cervix.

Keywords: High grade neuroendocrine tumours, well-differentiated neuroendocrine tumours, carcinoid tumours.

Citation: IeJSME 2017 11(1): 2-11

DOI: https://doi.org/10.56026/imu.11.1.2