Suboptimal management of asthma can lead to increase morbidity and mortality. Unfortunately, this has become global issue and approximately 40% of asthmatic patients received suboptimal management in emergency department. Therefore, this study aimed to develop a tool to assess knowledge and clinical reasoning of healthcare providers on acute asthmatic management in emergency setting.
Method: The tool was developed via three phases: (a) domain identification, (b) domain blueprinting based the Global Initiative of Asthma (GINA) and the British Thoracic Society (BTS) guidelines, and (c) item generation for each domain for assessing knowledge and clinical reasoning. Three forms of validity evidence related to content, response process and internal structure were appraised. Content validity index (CVI), face validity index (FVI), and intraclass correlation coefficient (ICC) estimate the content validity, response process and internal structure of the tool.
Results: A new tool was developed, named as Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED), which assesses knowledge and clinical reasoning on three domains related to management of acute asthma – diagnosis, treatment and disposition. CVI values for the three domains were more than 0.83. FVI values for the three domains among doctors and paramedics were at least 0.83. The ICC between scores given by emergency specialists was 0.989 (CI 95% 0.982, 0.994, p-value < 0.001).
Conclusion: The newly developed tool, named as K-CRAMED, is a valid tool to assess knowledge and clinical reasoning of healthcare providers who manage patients with acute asthma. Further validation is required to verify its validity in other setting.
Context: Question vetting is important to ensure validity, reliability, and other quality indicators of assessment tools, including the MCQ. Faculty members invest a substantial amount of time and effort into the MCQ vetting process. However, there is shortage of scientific evidence showing its effectiveness and at which level it needs to be focused on. This study aimed to provide scientific evidence regarding the effects of question vetting process on students’ examination performance by looking at their scores and pass-fail outcomes.
Method: A parallel randomized control trial was conducted on third year medical students in a medical school. They were randomly assigned into two equal groups (i.e. control and experimental). Two mock examinations were conducted (i.e. time I and time II). At time I, non-vetted MCQs were administered to both groups as a baseline measurement. At time II, vetted MCQs were administered to the experimental group, while the same non-vetted MCQs were administered to the control group.
Results: Out of 203 students, 129 (63.5%) participated in both mock examinations. 65 students were in the control group and 64 students were in the experimental group. Statistical analysis showed no significant differences (p > 0.05) in mean examination scores and pass-fail outcomes between or within the control and experimental groups.
Conclusion: This study indicated that the MCQ vetting process did not influence examination performance. Despite these findings, the MCQ vetting process should still be considered an important activity to ensure that test items are developed at the highest quality and standards. However, it can be suggested that such activity can be done at the departmental level rather than at the central level.
Introduction:Clinical characteristics to differentiate stroke subtype may be helpful to make sound decisionin managing blood pressure in clinically stroke patients. This is more important while en route patient to tertiary centre forneuroimaging facility and neurosciences services. The objective of this study is to determine the distinction between ischaemic and haemorrhagic stroke based on the clinical characteristics. Time of presentation was also calculated to determine the feasibility of thrombolytic therapy among stroke patients in Malaysia.
Methods:A cross-sectional observational study of all stroke patients presented to Hospital Kuala Lumpur from January 2005 to May 2005. All patients were subjected to brain CT. Clinical characteristics –age, gender, loss of consciousness (LOC), headache, vomiting, Glasgow coma scale (GCS), systolic blood pressure and diastolic blood pressure –were assessed. Time of presentation was also determined. Multiple logistic regression analyses with the stroke types as the outcome (ischaemic=1 vs haemorrhagic stroke=0) were performed.
Results:A total of 143 patients (88 male and 55 female) were included. The mean age for haemorrhagic stroke was 51.1 (± 14.9) years oldand mean age for ischaemic stroke was 56.8 (± 9.7) years old.Our logistic model shows five clinical characteristics were associated with types of stroke–age, GCS, sex, headache and LOC. Male (adj. OR 0.18, 95% CI 0.05-0.59), headache (adj.OR 0.16, 95% CI 0.06-0.47), LOC (adj.OR 0.20, 95% CI 0.06-0.66), age in years (adj OR 1.06, 95% CI 1.01-1.11) and GCS (adj.OR 1.44, 95% CI 1.14-1.82)wereall significant (p-value < 0.05) in our model. Only 4.9% patients presented less than 3 hours and most of them (64.3%) presented more than 6 hours.
Conclusion:Male patients, having LOCandheadache were the clinical characteristics predictive of lower chance of having ischaemic stroke. But, increasing age and higher GCS were more likely to associate with ischaemic stroke. BP in clinically stroke patients that have higher odds for haemorrhagic stroke should be lowered with a target of SBP ≥ 140mmHg. There was significant delayed of presentation for stroke patients. Many factors need to be improved to reduce the time of presentation in the future.
Severe acutepoisoning of cypermethrin is rare. We reportedthiscase about a47-year old man who was brought to the Emergency Departmentwith drowsiness and drooling of saliva after intentional self-harm with 2.25gram of cypermethrin.His initial condition was stable. However, nine hours after admission, he developed seizures and reduced conscious level. He was ventilated overnight for airway protection. Management of acute severe poisoning is discussed in this case report.
Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.