Clinical knowledge management at the point of care

Posted Posted in Review Articles

Author: Cheong-Lieng Teng

ABSTRACT

In the developing world, clinical knowledge management in primary care has a long way to go. Clinical decision support systems, despite its promise to revolutionise healthcare, is slow in its implementation due to the lack of financial investment in information technology. Point-of-care resources, such as comprehensive electronic textbooks delivered via the web or mobile devices, have yet to be fully utilised by the healthcare organisation or individual \ clinicians. Increasing amount of applicable knowledge of good quality (e.g. clinical practice guidelines and other pre-appraised resources) are now available via the internet. The policy makers and clinicians need to be more informed about the potential benefits and limitations of these new tools and resources and make the necessary budgetary provision and learn how best to harness them for patient care.

Keywords: knowledge management, primary health care, clinical decision support system, point-of-care resources.

Citation: IeJSME 2012: 6 (Suppl 1): S137-S141

DOI: https://doi.org/10.56026/imu.6.Suppl1.S137

A review of maternal mortality in Malaysia

Posted Posted in Review Articles

Author: Hematram Yadav

ABSTRACT

There has been a significant decline in maternal mortality from 540 per 100,000 live births in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from 6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.

Keywords: Maternal mortality, Risk Approach in MCH Care, Confidential Enquiry, Malaysia.

Citation: IeJSME 2012: 6 (Suppl 1): S142-S151

DOI: https://doi.org/10.56026/imu.6.Suppl1.S142

Growing professionalism in pharmacy students

Posted Posted in Review Articles

Author: Peng-Nam Yeoh

ABSTRACT

IMU is one of 17 institutions of higher learning conducting the Bachelor of Pharmacy course in Malaysia. The White paper on pharmacy student professionalism by the Task Force of the American Pharmaceutical Association Academy of Students of Pharmacy together with the American Association of Colleges of Pharmacy Council of Deans mentioned 10 essential traits of a professional, recommending their early development. Since the beginning of the IMU Bachelor of Pharmacy (BPharm) (Hons) course in July 2004 on Registration Day, IMU has adopted the concept of developing professionalism in the pharmacy student from the very first day of university, by having the White Coat Ceremony where the entire class takes the Pledge of Professionalism (adapted from the Task Force) against the “Code of Conduct for Pharmacists and Bodies Corporate” by the Pharmacy Board of Malaysia in the presence of the Senior Director of the Pharmaceutical Services Division of the Ministry of Health, Malaysia and the President of the Malaysian Pharmaceutical Society (MPS). Throughout their 4 years in IMU, the pharmacy students are exposed to various aspects of professionalism in different subjects in their curriculum. On 23rd April 2012, when the fifth cohort of BPharm students received their final examination results, “Pharmacy Professional Day” was launched. The graduating students took the Oath of a Pharmacist (adapted from the American Association of Colleges of Pharmacy’s Oath with slight amendment). Talks by alumni and speakers from MPS aimed to facilitate the transition of the new graduate to working life as a pharmacist.

Keywords: Pharmacy, White-Coat-Ceremony, Professionalism, Oath of a Pharmacist.

Citation: IeJSME 2012: 6 (Suppl 1): S152-S154

DOI: https://doi.org/10.56026/imu.6.Suppl1.S152

Developing a Chinese Medicine programme in a western medical university

Posted Posted in Review Articles

Author: Wenxin Zhou

ABSTRACT

Chinese medicine is one of the most famous traditional medicines in the world with a glorious and long written  history of at least 2000 years. Recently, acupuncture and the use of other herbal medicine are being gradually accepted globally. In 2011, the International Medical University (IMU) started the Chinese Medicine programme which is the first of its kind in a western medicine university in Malaysia. The author introduced the background of Chinese medicine and the curriculum of the Chinese Medicine programme established in IMU, analyzed the situation regarding the quality of lectures given by internal and external lecturers in this programme and also discussed on ways to integrate western and traditional medicine in IMU or in Malaysia. The launching of Chinese medicine in IMU is a great step in the development of IMU and also an important step in the development of medical education in Malaysia or even in South-east Asia.

Keywords: Chinese medicine, integrated western and traditional medicine, medical education.

Citation: IeJSME 2012: 6 (Suppl 1): S155-S158

DOI: https://doi.org/10.56026/imu.6.Suppl1.S155

Thyroid disorders in the aged

Posted Posted in Review Articles

Author: Peter Michael Barling

ABSTRACT

A review of current information related to the likely incidences of thyroid diseases in the aged population of Malaysia, raising issues such as the need for further epidemiological studies of iodine intake in relation to thyroid diseases within different geographical regions and population subtypes, the need for general country-wide iodization of salt, and the screening of elderly Malaysians for so-called “occult” thyroid diseases.

Keywords: Thyroid, iodine, hyperthyroidism, hypothyroidism, co-morbidity, goiter, thyroid nodules, rural population, TSH, atrial fibrillation.

Citation: IeJSME 2013 7(2): 4-7

DOI: https://doi.org/10.56026/imu.7.2.4

Rat gingival model for testing drugs influencing inflammation

Posted Posted in Review Articles

Authors: Shaju P Jacob, Sonia Nath.

ABSTRACT

Preclinical drug testing is an important area in new drug development where animals are used. An ideal animal model for this is one which is simple, reliable and can be extrapolated to humans. Topical drugs for inflammation are conventionally tested on the skin of animals after induction of inflammation. A gingival model would be simple as inflammation can be induced naturally by the action of plaque. Rats are a popular animal model for testing drugs as well as to study various diseases of the periodontium. Periodontal disease including gingival inflammation develops in rats in relation to indigenous plaque or experimentally induced bacterial products. A number of features of rats ranging from anatomy, histology and response to bacterial insult can be seen mirrored to a great extent in humans. There is a lot similarity in the development and resolution of inflammation as well as the gingival wound healing of rats and humans. This paper tries to explore the feasibility of using the rat gingival model for preclinical testing of drugs acting on or influencing inflammation and concludes by identifying potential areas of research using this model. The addition of such a simple and inexpensive model for preclinical testing of drugs will be welcomed by the drug developers.

Keywords: Animal model; periodontal; preclinical drug testing.

Citation: IeJSME 2013 7(2): 8-16

DOI: https://doi.org/10.56026/imu.7.2.8

Shock in the neonate

Posted Posted in Review Articles

Authors: Davendralingam Sinniah, Thiruselvi Subramaniam, Myint Myint Soe-Hsiao.

ABSTRACT

Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.

Keywords: neonatal shock, pathophysiology, classification, investigation, management.

Citation: IeJSME 2013 7(2): 17-28

DOI: https://doi.org/10.56026/imu.7.2.17

Changing trends in informed consent

Posted Posted in Review Articles

Author: Victor Lim

ABSTRACT

Consent is defined as the “voluntary agreement to or acquiescence in what another person proposes or desires”. In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public’s expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient’s signature on a consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation.

Keywords: informed consent, ethics, medical litigation, medical professionalism.

Citation: IeJSME 2014 8(1): 3-7

DOI: https://doi.org/10.56026/imu.8.1.3

Decision making in hyperglycaemia seen in pregnancy

Posted Posted in Review Articles

Authors: Kavitha Nagandla, Sivalingam Nalliah.

ABSTRACT

Delay in childbearing, family history of type 2 diabetes mellitus and obesity in childbearing years increases a possibility of glucose intolerance or overt diabetes in pregnancy which may remain unrecognised unless an oral glucose tolerance test is done. The International Association of Diabetes and Pregnancy Study Group (IADPSG, 2010) recommended the detection and diagnosis of hyperglycaemic disorders in pregnancy at two stages of pregnancy, the first stage looking for ‘overt diabetes’ in early pregnancy based on risk factors like age, past history of gestational diabetes and obesity and the second stage where ‘gestational diabetes’ at 24-28 weeks with 75 g oral glucose tolerance test. Although the one step approach with 75 g of glucose offers operational convenience in diagnosing gestational diabetes, there are concerns raised by the National Institute of Health in the recent consensus statement, supporting the two step approach (50-g, 1-hour loading test screening 100-g, 3-hour oral glucose tolerance test) as the recommended approach for detecting gestational diabetes. Medical nutrition therapy (MNT) with well-designed meal plan and appropriate exercise achieves normoglycemia without inducing ketonemia and weight loss in most pregnant women with glucose intolerance. Rapidly acting insulin analogues, such as insulin lispro and aspart are safe in pregnancy and improve postprandial glycemic control in women with pre-gestational diabetes. The long acting analogues (Insulin detemir and glargine) though proven to be safe in pregnancy, do not confer added advantage if normoglycemia is achieved with intermediate insulin (NPH). Current evidence indicates the safe use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes as other options. However, it is prudent to communicate to the women that there is no data available on the long-term health of the offspring and the safety of these oral hypoglycemic drugs are limited to the prenatal period.

Keywords: Diabetes, Pregnancy, Medical Nutrition Therapy, Insulin.

Citation: IeJSME 2014 8(1): 8-18

DOI: https://doi.org/10.56026/imu.8.1.8