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

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

Author: Joon Wah Mak

ABSTRACT

There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers’ perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered.

Keywords: ethical and responsive research, research needs, developing countries, resource allocation, research stakeholders.

Citation: IeJSME 2014 8(1): 19-23

DOI: https://doi.org/10.56026/imu.8.1.19

Author: Abu Bakar Suleiman

Keywords: Hippocratic Code, commitment, modern medicine, medical ethics.

Citation: IeJSME 2015 9(1): 3-8

DOI: https://doi.org/10.56026/imu.9.1.3

Authors: Mini Rani Mary Beth, Pek Hong Lim, Chitra Rathina Pandi.

ABSTRACT

Interprofessional learning (IPL) promotes collaboration among healthcare professionals in providing quality healthcare. For the IPL to have a positive influence on inter-professional collaboration, opportunities must be made available for the healthcare students to learn together. Attitudinal factors have been identified as the major factor hindering the implementation of IPL. In Malaysia, little is known about attitudes of healthcare students towards IPL. Students from different health disciplines often have poor conception of each other’s roles as a member of the healthcare team. IPL increases this knowledge and gives students an understanding of the interpersonal skills needed for liaison and communication. Students from different disciplines who learn together develop interpersonal and teamwork skills, and gain knowledge of how other professionals work. IPL has been shown to create teams that work together better and improve patient experience. In general, IPL aims to improve patient safety, enhance patient satisfaction, and increase levels of innovation in patient care, and increase staff motivation, well-being and retention. There has been increasing emphasis on the important role that interprofessional education (IPE) must play in educating and developing present and future healthcare professionals. This review aims to examine how learning outcomes are articulated in the field of IPE and includes the benefits, importance, ethical concepts and application of IPL in nursing.

Keywords: Interprofessional learning, Nursing education, experiential learning, ethical competency.

Citation: IeJSME 2015 9(1): 9-20

DOI: https://doi.org/10.56026/imu.9.1.9

Authors: Peter Michael Barling, Yi Huan Foong.

ABSTRACT

Keriorrhoea is the involuntarily passing of orange oil per rectum. One of us (PMB) had the misfortune to experience this symptom, together with considerable gastrointestinal disturbances for a prolonged period of time after consumption of a deep sea fish, orange roughy, which is rich in liquid wax esters (LWEs). This paper presents a summary of available evidence concerned with the physiology and pathology of ingestion of LWEs, which can enter the human diet in substantial amounts from consumption of several species of deep-sea fish. LWEs are poorly digested and absorbed by the human body. They generally cause keriorrhoea when ingested deliberately or accidentally. Jojoba oil, which is a plant LWE, together with certain nutritional products (e.g. olestra) and medical (e.g. Orlistat) which are not LWEs may mimic the effects of LWEs, and cause similar gastrointestinal disturbances. This paper discusses the potential effects of LWEs as components of gastrointestinal micelles, and predicts that the orange oil which is leaked from a bout of keriorrhoea may contain considerable volumes of triacylglycerols (TAGs).

Keywords: keriorrhoea; liquid wax esters; orange roughy; escolar; oilfish; lipase; 2-monoglyceride.

Citation: IeJSME 2015 9(1): 21-25

DOI: https://doi.org/10.56026/imu.9.1.21

Authors: Pei Kuan Lai, Sivalingam Nalliah, Cheong Lieng Teng, Nicole Lee Ping Chen.

ABSTRACT

The impact factor (IF) of a journal, first proposed by Garfield has evolved over the years as an evaluation tool for comparing scholarly journals. Over the past few decades, the utilization of IF has extended beyond the tool for acquisition of journals in libraries and proxy for quality and importance of published journals. Nowadays, IF has been widely used as a surrogate for article quality, assessment of individual researcher’s achievement, criteria to secure tenure and job promotion, as well as evaluation tool for the application of research grant or funding. This review addresses the historical perspective of IF and its evolution, the controversial issues leading to the manipulation by journal editors or authors, and followed by some of the interventions to overcome the manipulations and controversies. IF itself has many drawbacks and shortcomings worth addressing as they will lead to bias as a citation index. The scientific community should pay attention to call for a better citation metric which will prove to be an improved yardstick of science. This paper also covers on other citation metrics and their emerging usages as parameter for evaluation of scientific publication quality.

Keywords: Impact factor, bibliometry, citation metrics.

Citation: IeJSME 2019 13(2): 4-11

DOI: https://doi.org/10.56026/imu.13.2.4

Authors: Sangeetha Shyam, Snigdha Misra, Megan Hueh Zan Chong, Rokiah Don.

ABSTRACT

The high and growing prevalence of obesity in Malaysia is a public health concern. There is a growing effort towards creating an environment that supports healthy lifestyles through instituting appropriate public health policies. The Sweetened Beverages Excise Duty is a recent initiative in this direction that was enforced on July 1st, 2019. In this status update, we trace the developments in the implementation of the tax. This paper collates the preparatory considerations preceding the implementation of the tax, the proposed objectives of the tax, its format as reported in the media. The early sentiments expressed by the stakeholders in the duration leading to the implementation and immediately after (10 days’ post-implementation) the enforcement of the duty are also presented here. This preliminary information will be useful to evaluate the effectiveness of this newly introduced Sweetened Beverages Excise Duty in Malaysia.

Keywords: Sugar tax, obesity, Malaysia, sugar sweetened beverages, policy.

Citation: IeJSME 2019 13(2): 12-22

DOI: https://doi.org/10.56026/imu.13.2.12