IIUM Medical Journal Malaysia (IMJM)
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Using the Theory of Motivated Information Management to Understand Direct Information Seeking on COVID-19 from Close Contacts
Get PDFINTRODUCTION: As the COVID-19 pandemic spread like wildfire in 2020, initially, little was known about the pandemic. Various parties including local governments, health agencies, medical researchers, and frontliners made concerted efforts to ensure the accuracy, timeliness, and reliability of the information released to the public. Accordingly, a major focus of this study is to examine the factors influencing COVID-19 direction information seeking from close contacts as determined by the theory of motivated information management (TMIM). MATERIALS AND METHODS: A cross-sectional survey using Google form was distributed to undergraduate students pursuing communication courses at public universities in Malaysia. RESULTS: Out of six hypotheses, only two are not supported. Consistent with TMIM, outcome expectancy and target efficacy predict direct information seeking on COVID-19 from close contacts. Further, target efficacy mediates the relationship between outcome expectancy and direct information seeking. CONCLUSION: Overall, the study found empirical support for TMIM as a useful framework for understanding COVID-19 information management. The repercussions of these findings on TMIM as well as key factors that may influence decision-making on information seeking during a global health pandemic are also discussed.
Bleed or Clot? Managing Bleeding in Post Thrombolysis Patient with Massive Pulmonary Embolism Who Underwent Recent Major Cancer Surgery
Get PDF51 years old female, with invasive left breast cancer stage T3N0M0 developed syncope, hypotension, chest pain, and ST elevation in anterior leads on the next day following Left Mastectomy. The initial diagnosis of AMI revised to massive pulmonary embolism after tranthoracic enchocardiogram. However, IV (intravenous) Metalyse was given as thrombolysis therapy and the patient showed a good initial response. Subsequently, the patient developed massive bleeding from the surgical site. Bleeding was successfully controlled with total of 11 units packed cells, 4 units fresh frozen plasma, 4 units of platelet, and 6 units of cryoprecipitate as well as prothrombin complex concentrate. Local compression bandage and continuous surgical site drainage were applied in this case. Following successful control in bleeding unfractionated heparin infusion was given for 2days followed by low molecular weight heparin for 2days and discharged with a direct oral anticoagulant. On follow up visit, the patient made an excellent recovery and planned for further treatment for breast cancer. Thrombolysis therapy and anticoagulant therapy in post-operative patients with high-risk bleeding posses great challenges. Careful evaluation of bleeding versus clotting is the key to good outcomes
Understanding How Malaysian Women Appraise their Breast Cancer Symptoms: A Narrative Approach
Get PDFINTRODUCTION: Awareness of breast cancer symptoms has made a positive impact on recognition and screening, however there is little research describing how women interpret their bodily changes. This study was conducted to explore how Malaysian women with breast cancer appraise their symptoms and how their interpretation of the symptoms had been shaped by the social norms, knowledge and previous experiences. Materials and Methods: 14 women with breast cancer were recruited using purposeful sampling. The participants took part in in-depth, one-time, face-to-face, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analysed using structure and content of a narrative approach. Results: Women interpreted their symptoms based on the physical presentation of the symptoms, previous experiences, and societal norms and beliefs. Some women immediately understood the potential meaning of their breast changes and sought medical opinion, while others waited from one week up to until one year to observe symptoms or normalised them in terms of previous and current experiences. The use of narrative enabled these women to recapitulate particular experiences that had special meaning in order to make sense of their action. Conclusions: The way women interpreted their symptoms reflected their understanding on the significant meaning of the symptoms. Acknowledging this symptom appraisal information may assist healthcare professionals in providing appropriate information that can challenge misconceptions, myths, and negative beliefs about breast cancer to improve breast cancer awareness and early detection among the community.
Effect of Acacia Honey Drink Consumed Pre and During Exercise on Glucose Metabolism, Total Antioxidant Status, and Running Performance in the Heat
Get PDFIntroduction: This study investigated the effects of Acacia honey drink on glucose metabolism, plasma total antioxidant status, selected physiological parameters and time trial running performance in the heat compared to a commercially-available sports drink. Materials and methods: Ten participants completed two endurance running trials in the heat with either honey drink (H) or sports drink (SPD) ingestion. Honey drink or sports drink was ingested one hour prior to the experimental trials. Participants warmed up for 5 min by running at 50% of their respective VO2max, and subsequently ran at 60% of their respective VO2max for 1hour. This was immediately followed by a 20 min time trial running performance. Participants drank 3 mL.kg body weight-1 of cool honey or sports drink every 20 min during the trials. Blood samples were collected for subsequent biochemical analysis. Results: Plasma glucose, insulin, cortisol, total antioxidant status and running performance were not statistically different between H and SPD trials. These findings indicated that Acacia honey drink and sports drink ingested before and during exercise elicited similar effects on glucose metabolism and endurance running performance. Conclusion: Acacia honey has potential to be used as an alternative ergogenic aid for athletes who train and compete in a hot and humid environment
Molecular Prevalence of Ent amoeba histolytica and Ent amoeba dispar Infection among Aboriginal Communities in the Southern Region of Perak, Malaysia
Get PDFINTRODUCTION: In Malaysia, there are little up-to-date data on the prevalence of Ent amoeba spp. and most of the previous studies were carried out using the conventional insensitive method of stool microscopic examinations. MATERIALS AND METHODS: A cross-sectional study was conducted from September 2018 to Mac 2019 in the three villages of Orang Asli communities at Slim River, Perak using the molecular assay. Risk factors associated with Ent amoeba spp. infection was assessed by analysing questionnaire responses obtained from the study participants. RESULTS: From the 55 stool samples collected, molecular prevalence revealed 7.3% and 9.1% E. histolytica and E. dispar infection respectively. Infection was due to indiscriminate defecation and not washing hands after playing with soil or gardening, as well as associated with gastrointestinal symptoms. CONCLUSION: This study showed that there is still an ongoing transmission of Ent amoeba spp. among the studied population, thus warrants the implementation of specific prevention and control strategies of this infection in Malaysia
Bitemporal Blindness in Traumatic Head Injury
Get PDFWe report a case of isolated bitemporal hemianopia in traumatic chiasmal syndrome. A 20-year-old male motorcyclist was brought unconscious into the emergency department after an alleged accident involving a horse-drawn vehicle. He was intubated for three days. Computed topography of the brain revealed bifrontal and facial bone fractures, associated with subarachnoid haemorrhage. He underwent frontal bone and facial bone reconstruction. Three weeks later, patient complained of left eye blurred vision. On examination, the visual acuity was 6/7.5 in the right eye and 6/12 in the left eye, with a left relative afferent pupillary defect. Visual field charting showed complete bitemporal hemianopia. Over the next six months, the visual acuity of the left eye worsened to 6/45, while the field defect remained static. Bitemporal hemianopia in traumatic chiasmal syndrome is a rare complication of severe head injury. A history of trauma should always be elucidated in patients with visual field defects.
Differences in Attitude towards End-Of-Life Care among Haemodialysis Patients and their Family Members in Two Malaysian Hospitals
Get PDFINTRODUCTION: End-of-life (EOL) care has become an important topic of discussion in those with chronic illness, especially in End Stage Renal Disease (ESRD) patients on dialysis. This study explored attitudes towards the EOL care among haemodialysis patients and compared them with the patients’ family members. MATERIALS AND METHODS: The study was a cross-sectional descriptive study conducted in two tertiary hospitals in Malaysia. The data was collected by using a survey questionnaire from 164 participants which consisted of 82 pairs of patients and their relatives. RESULTS: ‘Patient’ and ‘family’ groups demonstrated differences in their preferences regarding EOL care options. Family members group favoured cardiopulmonary resuscitation (81.7% vs 41.4%) (p <0.001), endotracheal intubation (80.5% vs 43.9%) (p = 0.989) and nasogastric tube feeding (87.8% vs 67%) (p = 0.001) more than patients themselves. The physician was the most nominated surrogate decision-maker by the patient (91.5%). Majority of the patients (57.3%) felt uncomfortable discussing EOL care options. There was significant correlation between duration of dialysis and patients’ EOL preferences where patients less than 5 years on haemodialysis favoured CPR (55.9% vs 31.3%; p = 0.026), intubation (55.9% vs 35.4%) and nasogastric tube feeding (82.3% vs 56.3%; p = 0.013) compared to patients who had been on haemodialysis for 5 years or longer. CONCLUSION: This study demonstrated significant differences between the attitudes of the patients and their relatives regarding EOL care preferences.
Dilemma in the Treatment of Paediatric Vagal Paraganglioma
Get PDFVagal paraganglioma is a rare tumour of the head and neck region, particularly in the paediatric age groups. A 13-year-old girl presented at the Department of Otorhinolaryngology, Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre Malaysia with painless left neck swelling, associated with multiple cranial nerve palsies for 14 months. The neck swelling was diagnosed as a carotid body tumour initially, but it was deemed inoperable, and the child received radiotherapy instead. The treatment response was suboptimal. Upon re-evaluating the radiological images, a revised diagnosis of vagal paraganglioma was made. Her family refused surgical intervention, and the child was treated conservatively. Over the last four years, serial imaging has demonstrated a decrease in tumour size. Although vagal paraganglioma in paediatric may require surgical excision, there is still a role in the wait-and-see approach. Frequent follow-up with radiological surveillance can save patients from surgical morbidity
Massive Open Online Course (MOOC) in Continuous Nursing Education (CNE): Contributions and Challenges: A Review
Get PDFbecomes an important aspect of the health care system and the growth in quality of health care education process. Continuous nursing education (CNE) is a lifelong professional development to enhance the knowledge, skills and attitude of nurses for the development of nursing practice, education, administration and research. The development of massive open online course (MOOC) which is an e-learning platform, has changed the approach of continuous education. However, the pedagogy in MOOC CNE is still under-developed. Although numerous roles for MOOC have been proposed in both in and out campus for nursing programs, a clear rationale for their effectiveness is still nascent. This review attempts to explore MOOC and its contributions and challenges in CNE. Literature search was conducted on articles published between 2010–2020 in Ovid MEDLINE, Embase Ovid, Ovid Emcare and CINAHL Plus databases, ScienceDirect, Web of Science, ProQuest and the Google Scholar whereby only English-language and peer-reviewed journal articles were included. Eight articles were selected for review and three aspects were extracted: i) history of MOOC, ii) characteristics of MOOC in health care, and iii) its contributions and challenges to lifelong learning as well as CNE. The findings provided valuable insights about MOOC based CNE as an inspiring approach that holds a great potential to offer credible, cost-effective and readily accessible contents to the health care provider
Complementary Thyroid Elastography on Conventional Ultrasound in Diagnosis of Malignant Thyroid Nodules
Get PDFINTRODUCTION: Ultrasound has been widely used to assess thyroid nodules. Although ultrasound elastography has been developed to improve detection of thyroid malignancy, it has received mixed responses. This study aimed to determine the efficacy of ultrasound elastography in detecting malignant thyroid nodules. MATERIALS AND METHODS: Patients with thyroid nodules were assessed using conventional ultrasound and elastography followed by fine-needle aspiration and or hemithyroidectomy. The ultrasound findings were compared with the cytology or histopathology for statistical analysis. RESULTS: Out of 156 nodules from 92 patients included in the study, 12 (7.7%) were malignant and 144 (88.8%) were benign. The elastography was found to be an independent predictor of malignancy (OR 10.35, 95% CI [1.31, 81.6], p = 0.03). Other independent predictors were taller shape and central Doppler pattern obtained using conventional ultrasound. A combination of the three independent predictors was shown to improve the sensitivity of detecting malignant thyroid nodules up to 100%, 95% CI [73.5,100] with NPV of 100%. A new scoring system incorporating the three variables was developed and an algorithm using the scoring system was proposed. CONCLUSION: Thyroid elastography is an independent predictor of thyroid malignancy. Its performance is comparable to conventional ultrasound when used alone and improved when used in combination with conventional ultrasound. It is valuable as screening and risk-stratification tools for patients with thyroid nodules.