The objective of the study was to determine the proportion of sound HIV knowledge and common misconceptions about HIV among university students. A set of pre tested and validated questionnaire assessing sound HIV knowledge and common misconceptions about HIV was used in this cross sectional study. HIV knowledge was defined as sound when one was able to identify correctly two ways of preventing the sexual transmission of HIV and reject three major misconceptions about HIV. Out of 300 respondents, 298 completed the questionnaire giving a response rate of 99.3%. A total of 40.9% of university students have sound HIV knowledge. The majority of those who lacked sound HIV knowledge were young (60.2%) and female (60.4%). A significant proportion still believed that HIV can be transmitted via social contact (13.8%), by sneezing or coughing (11.4%) and mosquito bites (10.1%). About 6.7% were believed wrongly that HIV can be treated by vaccine and healthy-looking people cannot have HIV.
Study site: Universiti Putra Malaysia (UPM), Malaysia
Introduction: Increased nociceptive responses were shown in the offspring of prenatally stressed rats. Reports have demonstrated the anti-nociceptive effects of Tualang honey in the rat offspring. The present study was done to de- termine whether the modulation of nociceptive behaviour by Tualang honey was mediated by modulating changes in the histology, oxidative stress parameters and N-methyl-D-aspartate (NMDA) receptors in the thalamus of the rat offspring. Methods: Eighteen Sprague Dawley pregnant rats were randomly assigned to control (C), stress (S) and stress-treated with Tualang honey (SH) groups. Stress was given in a form of restraint stress.Tualang honey was given to SH group from first day of pregnancy until delivery. Thirty-three adult male offspring were subjected to formalin test before they were sacrificed. Nociceptive behaviour score, number of neurons, level of oxidative stress parameters and NMDA receptors in the thalamus were analysed by using one-way ANOVA. Results: The study demonstrated a significant decrease in mean nociceptive behaviour score (p
Introduction: Early environmental factors play a major role in shaping the health of an individual. Dietary prefer- ence and habits shaped by parental feeding practice during childhood are likely to persist into adulthood which further determines body weights status. This study aimed to determine the retrospective child feeding practices asso- ciated with obesity risk in young adults. Methods: This was a retrospective cross-sectional study with 176 university students in Kuala Lumpur. Data of maternal age, gestational age and feeding practices were collected retrospectively using Child Feeding Questionnaire (CFQ). Subject’s current socio-demographic data was collected and anthropo- metric measurements were taken using standard protocol. Results: Around 22% of the subjects were overweight/ obese. No significant association was found between child feeding practices with maternal age. A significant asso- ciation (p
Introduction: Consumption of Chinese Herbal Medicine (CHMs) have escalated globally. They are preferred treat- ment for minor diseases or disorders. In Malaysia, CHMs are common home remedies during pregnancy and postpar- tum. Angelica sinensis (Danggui) is a staple CHMs during postpartum for purpose of nourishing blood and resolving stasis. Concerns are raised over possible heavy metals toxicity. Objective: This study aims to (i) determine Danggui consumption among postpartum mothers, (ii) quantify its heavy metals level, namely Lead (Pb), Cadmium (Cd), Ar- senic (As) and Chromium (Cr) and (iii) determine health risks of Danggui consumption among mothers. Methods: A cross-sectional study involving 112 postpartum mothers was carried out in Kuala Lumpur. Danggui samples were collected from nine districts in Kuala Lumpur (Segambut, Seputeh, Cheras, Kepong, Bandar Tun Razak, Titiwangsa, Setiawangsa, Batu and Lembah Pantai). Heavy metals were extracted using microwave digester and analysed using Inductively coupled plasma mass spectrometry (ICPMS). Hazard Quotient (HQ) was used to determine non-carcino- genic health risks for herbal medicine consumption. Results: Danggui was consumed by 19.6% of mothers (n=22). Among them, incidence of jaundice was 63.6% and need for phototherapy was 40.9%. Heavy metals contamina- tions were found in the decreasing order of Cr > As > Pb > Cd with median (interquartile) of 3996.3 (2805.6) μg/ kg, 128.3 (56.7), 98.6 (99.1) and 37.0 (35.0) respectively. No non-carcinogenic health risks were found for all four metals. Conclusion: Alarming concentrations of heavy metals were quantified in Danggui warranting for further in- vestigation to safeguard health of postpartum mothers.
Introduction: The USM Pre-clinical medical students’ guidance and counselling needs questionnaire (USM-MS- GCN-Q) is an English-language guidance and counselling needs questionnaire which was developed specifically for pre-clinical medical students. The aim of this study is to highlight the construct validity of USM-MSGCN-Q among pre-clinical medical students. Methods: In June 2017, a cross-sectional study on 208 pre-clinical medical students was conducted in Universiti Sains Malaysia (USM). This self-administered USM-MSGNC-Q consisted of four constructs and 20 items with a 5-point Likert scale within each item. A confirmatory factor analysis was em- ployed to test the hypothesized measurement model. Results: The final measurement model fitted the data well. The four-factor model initially consisted of 20 items however, it was reduced to 18 items with the goodness of fit indices suggesting good model fit (RMSEA 0.89, GFI .915 and ChiSq/df 2.642). Internal consistency reliability (Cronbach’s alpha) was 0.879 for self-leadership skills, 0.929 for communication skills, 0.871 for learning skills, and 0.870 for psychological coping skills. The overall Cronbach’s value was 0.922. Respective composite reliability values were 0.879,0.952,0.879 and 0.835 while the Average Variance Extracted values were 0.729, 0.911, 0.595 and 0.630. Conclusion: This study has confirmed that self-leadership, communication, learning and psychological coping skills were the components of guidance and counselling needs which influences the effectiveness of guidance and coun- selling sessions with pre-clinical medical students.
Introduction: Unequal retinal image size (RIS) or aniseikonia is usually related with anisometropia. Higher dif- ferences of RIS may manifest symptoms such as dizziness, headache or disorientation. In worst case might cause suppression that leads to amblyopia. Current study aims to evaluate the consistency of aniseikonia measurement in Smart Optometry smartphone application among myopic, hyperopic, and astigmatic simulated anisometropia and real anisometropia groups. Methods: Fifteen real anisometropes (refractive error; -0.50 until -6.00 diopters; D) and fifteen emmetropes (refractive error: -0.25 until +0.50D) were recruited. Real anisometropes wore their habitual spectacle correction while each emmetropes were fitted using soft contact lenses of +4.00DS, -4.00DS and -4.00DC with base curve 8.6 and total diameter 14.2mm in random order to mimic myopic-, hyperopic- and astigmat- ic-anisometropia before testing. Participants with any ocular disease and binocular vision problem were excluded. The consistency of aniseikonia measurement was determined in two visits, separated by at least 24-hour interval. Three repetitive measurements were taken in each visit. Results: Independent t-test and paired t-test showed that real and simulated anisometropia gave insignificant aniseikonia percentage, p>0.05. ICC findings revealed moder- ate-to-good agreement for all simulated and real groups. Bland Altman analysis between two visits exhibited good agreement among all simulated group; myopic (mean difference 0.2047; 95%CI:-1.1386-1.549), hyperopic (mean difference 0.2200; 95%CI:-0.9286-1.3686) and astigmatic (mean difference 0.2533; 95%CI:-0.7114-1.2180). Real anisometropes demonstrated good agreement with bias value of 0.2247(95%CI:-0.9162-1.3656) using Bland Altman plot. Conclusion: Smart Optometry application provides consistent measurement of aniseikonia regardless any types of anisometropia.
Introduction: Diabetes is a chronic metabolic disease and noted to be incidence is intensifying globally and contem- plated as epidemic. The study is aimed to assess the coronary artery disease risk profile associated diabetes mellitus patient and to identify the clinical pharmacist care services in the management and to control the risk burden in the clinical practice. Method: A prospective observational study was conducted among the consecutive patients of coronary artery disease associated diabetic patients in a tertiary care teaching hospital over 6 months period. A sam- ple of 150 patients was recruited in the study. Data analysis was done with graph pad prism software 5.01. Results: The present study revealed that coronary artery disease in diabetes was more prevalent in age group between 41-50 years. About 54.66% patients with hyperlipidemia were at risk to develop the coronary artery disease complication. Glycated hemoglobin test was detected in 40% of the patient showing abnormal levels and around 43.33% of patient had an abnormal fasting blood sugar level. The study showed only 32% of patients was prescribed Insulin & oral hy- poglycemic agents and 13 % were treated with statins. Conclusion: It could be concluded that the causative factors should be controlled and treated with an early need for amalgamation of clinical pharmacist care services with the health care team on life style modification counseling could ultimately improve the patient health outcomes and also lowers progression of coronary artery disease risk complications among diabetic patients.
Introduction: Proper distribution of human resources is an important factor ensuring high-quality performance and sustained service quality. The aim of this study was determining the workload pressure among medical officers in health clinics (HCs) in Kelantan. Method: A record review survey was conducted between January and April 2019 using human resources data for 2018 involving HCs in Kelantan. It included all the HCs in Kelantan and excluded community clinics. Workload pressure was determined using a tool known as Workload Indicator of Staffing Needs, developed by World Health Organization. A high workload pressure was defined as a ratio between required and acquired medical officers of less than 1. The data were presented descriptively using as frequencies and percentages. Results: All 85 HCs in Kelantan were involved in the study; 90% (9/10) of the Kelantan districts recorded high work- load pressure. Moreover, 68.2% (58/85) HCs had high workload pressure. Tanah Merah, Tumpat, Pasir Mas, and Kota Bharu had the most HCs with high workload pressure, and most such HCs were found in areas with a high-den- sity population, requiring huge coverage. Conclusion: The Kelantan State Health Department should develop better human resource distribution strategies to ensure the sustainability of quality care in HCs.
Introduction: The outbreaks of foodborne diseases have been linked to the consumption of contaminated seafood. This research aims to screen the bacteria from the sea cucumbers Acaudina molpadioides collected from Pulau Langkawi. Methods: A total of 22 sea cucumber samples were collected randomly from Pulau Langkawi, Kedah, Malaysia. The samples were isolated and identified for the presence of bacteria using the conventional culture-based method. Presumptive bacteria colonies were subjected to various biochemical and antimicrobial susceptibility tests. Results: There were no bacterial growth in Hektoen Enteric (HE) agar and Thiosulphate-Citrate-Bile Salt (TCBS) agar. Positive samples were isolated from MacConkey (MAC) agar with 6 samples were Staphylococcus spp. (27.27%), 14 samples were Proteus spp. (63.63%) and 2 samples were Bacillus spp. (9.01%). Among these isolates, highest resistance was found against Ampicillin (45%) followed by Tetracycline (40%). Conclusion: The results indicate that the sea cucumbers Acaudina molpadioides were contaminated with potential bacteria. There is a need for adequate consumer protection measures.
Introduction: Measles outbreaks are endemic in Southeast Asia. A possible reason for such outbreaks is low vaccine coverage. In Malaysia, there is a lack of studies on measles outbreaks. The urban district of Petaling in Selangor, Peninsular Malaysia, reported a high number of outbreaks in 2014–2018. Thus, we analysed the trend of mea- sles outbreaks and identify the common characteristics of measles cases in Petaling District. Methods: This was a cross-sectional study using secondary data from the Petaling District Health Office online surveillance system. Data from 2014 until 2018 from the e-Measles and eWabak systems were extracted, and the trend and common character- istics of measles cases were analysed. Results: A total of 48 outbreaks involving 124 cases were reported during the period investigated. The outbreaks showed an increasing trend from 2.1% in 2014 to 37.5% in 2016, and decreased slightly from 29.2% in 2017 to 27.1% in 2018. The common characteristics were age 1 to
Introduction: This preliminary cross-sectional study aimed to investigate the prevalence of toxoplasmosis among blood donors in Kelantan, Malaysia. Methods: A total of 56 blood donors were screened by an enzyme-linked immu- nosorbent assay (ELISA) for anti-T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies. Positive
T. gondii IgG and IgM were further tested for IgG avidity ELISA. All extracted deoxyribonucleic acids (DNAs) from whole blood samples were analyzed for the presence of the Toxoplasma B1 gene and the ITS1 region by polymerase chain reaction (PCR). The socio-demographic data of donors was assessed using a data collection form. Results: Out of 56 blood donors, 24 (42.86%) donors were IgG+/IgM-, and 2 (3.57%) donors were IgG+/IgM+ with one of them having a high avidity index indicating as past infection for more than 20 weeks and the other with a low avidity index indicating as recent infection within 20 weeks. None of the samples tested positive for the presence of the Toxoplasma B1 gene and the ITS1 region. A univariate analysis showed that only employment status was significantly associated with Toxoplasma seropositivity. Conclusion: The seroprevalence of toxoplasmosis among blood donors in Kelantan, Malaysia, was 46.43%. Nevertheless, direct detection by PCR showed that this parasite was absent in the blood. These results highlight that the blood donors in this study had previously been exposed to T. gondii infection. The parasite may still remain in certain tissues but does not freely circulate in the blood.
Introduction: Delivering oral hygiene instruction is one of the integral parts of orthodontic treatment. However, there is scarce information regarding the impact of audiovisual method on knowledge retention among orthodontic patients. This study aimed to assess knowledge retention of the patient after instruction delivered in audiovisual (AV) method and compare it to the standard written and verbal (WV) method. Methods: This prospective clinical trial was conducted on 60 patients aged 13 to 40 years. They were randomized into the audiovisual group (n=30) and written & verbal group (n=30). Patients’ knowledge retention was measured using a self-administered questionnaire in Google form, immediately after instruction given as short-term retention and long-term retention for three time- point, i.e., 1-month, 3-month, and 6-month. Results: There was a significant improvement in knowledge for both AV and WV methods at immediate and 1-month assessment and the knowledge retained until 6-month follow up. The AV method demonstrated a significantly higher increase in knowledge retention at immediate and 1-month than the WV method. Conclusion: The AV method was significantly more effective in improving patient's knowledge reten- tion compared to the written & verbal methods. Repetition of instruction also influence the retention of knowledge.
Introduction: Iron deficiency anaemia (IDA) is endemic especially in the under-developed and developing countries and is a major public health concern. Improving nutrition is one of the ways to alleviate this condition. Consumption of locally available and affordable food such as date palm and goat milk which are rich in iron is one of the ways to overcome IDA. This study is aimed at evaluating the effect of date palm and goat milk supplementation on hae- matological parameters and iron bioavailability in IDA rats. Methods: 24 male Wistar rats were randomly divided into normal control and IDA group. The normal control was fed with normal diet and water ad libitum while the IDA group were fed on iron-deficient diet for two weeks to induce iron deficiency. The IDA rats were further divided into subgroups; each being supplemented with date palm, goat milk, a combination of date palm and goat milk, and ferrous fumarate as positive control. Blood were collected after 28 days for haematological parameters and iron profile determination. Iron bioavailability was assessed using the haemoglobin regeneration efficiency (HRE) index. Data was analysed by Student T Test and ANOVA using SPSS 23.0 software with p value < 0.05 considered as sta- tistically significant. Results: Supplementation of date palm and goat milk for 28 days significantly improved Hb, RBC, PCV, MCV, MCH, serum iron and transferrin saturation (p
Introduction: Pertussis is known to cause infection and reinfection to everyone irrespective of ages and countries. Therefore, adults do require vaccination for protection against pertussis infection especially the HCW. However, the pertussis vaccine coverage is low among HCW due to low-risk perception. Protection Motivation Theory (PMT) is one of the most cited theories to explain risk perception and intention to change. Therefore, we developed a questionnaire based on the subconstructs of the PMT to assess the acceptance of the pertussis vaccine amongst the HCWs in Sabah and Sarawak. The motive of this study is to validate this questionnaire to see its validity and reli- ability. Method: Data was collected using a self-administered questionnaire via an online survey (Monkey Survey). The questionnaire was given to 250 HCW. Items that were identified as a problem were modified to increase reli- ability. Further validation was done among 853 HCWs working in various parts of Sabah and Sarawak. Results: The Cronbach alpha of the overall construct of PMT during the first pilot study was 0.66 and improved to 0.82. Principal components factor analysis using varimax rotations showed that the first four factors explained 28%, 2%, 9% and 5% of the variance respectively. Both the one level and two-level modelling indicated that it’s a good fit model. Conclu- sion: The study instrument that was developed for the study has been tested and proven to be relevant to assess the risk perception of an HCW towards pertussis.
Introduction: Doctors are known to deal with high occupational stress, causing increased risk of depression, anxi- ety and stress.Nevertheless, the prevalence and associatedfactors of depression, anxiety and stress among registered doctorsworking in 24 public hospitals in Sabah, Malaysia are not known yet. Methods: This cross-sectional study was conducted using convenient sampling from September-October 2018. The data of 21-item Depression Anxiety Stress Scale (DASS-21) was collected via online link anonymously. Results: Among 314 doctors, majority of them were females (62.1%), mean age 29 (SD 2.72), non-Sabahan (82.8%), Malays (46.8%), not married (78.3%) and medical officers (93.6%). Prevalence of severe/extremely severe anxiety symptoms was 27.4%,depression (22.9%) and stress (18.5%). Doctors perceiving themselves to be depressed, anxious and/or stressed were more likely to develop the corresponding symptoms. Females and Chinese were twice more likely to report anxiety symptoms. Being married had protective effect against depressive symptoms, while working in same hospital for longer time had a significant but weak protective effect against anxiety and stress symptoms. Conclusions: Mental health issue among doctors is substantial and need to be addressed effectively for the benefit of their life, patients and country.
Introduction: Initially, studies showed that graphic warning signs (GWSs) on cigarette packages encouraged smok- ing cessation. However, there have been recent concerns over the effectiveness of GWSs to change smoker percep- tions and behavior over time. Our goals were to assess the latest perceptions of GWSs among smokers in Kelantan and to determine the factors associated with them. Methods: This cross-sectional study was conducted among re- spondents who attended outpatient clinics in a teaching hospital in Kelantan. Their perceptions were analyzed with a validated Malay questionnaire containing four domains: fear, influence, credibility, and picture content. Results: The average smoking age was 17 (3.04) years old. The mean smoking time was 11 (7.49) years. The average daily cigarettes smoked was 8 (6.26). Most respondents perceived low levels of fear (83%), poor picture content (65.5%), low influence (87.6%), and low levels of credibility (70.1%) in GWSs. Those with low levels of education were significantly associated with poor perceptions of GWSs. Conclusion: Despite vigorous efforts by the government to discourage smoking in Kelantan, smokers still poorly perceive GWSs. More effective health-promotion strategies are essential to influence smokers in this area.
ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019 (IHMSC 2019)
Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia, 8-9th March, 2019
Introduction: Unsafe blood products cause transfusion-transmissible infections among blood receivers. The knowledge and perception of blood donors is important as it is associated with their donation behaviour and hence the safety of blood products. There was no previous study that assessed the knowledge and perception on blood safety issues among blood donors to date. The objective of this study was to assess the knowledge and perception of blood
donors on blood safety issues.
Methods: This was a pilot study conducted to pilot test the self-developed questionnaire by the researchers. The questionnaire was available in the Malay language. One-hundred-thirty donors at the National Blood Centre were recruited to complete the self-administered questionnaire. Health sciences professionals, medical students and non-Malaysians were excluded in this study.
Results: A total of 130 donors comprising of 70 males (53.8%) and 60 females (46.2%) responded. The mean age of the respondents is 32.48±8.86 years. Most of the respondents were Malay (55.4%), single (49.2%), working in private sector (46.9%) and regular donor (68.5%). More than half of the respondents did not know that dengue, Zika and mad-cow disease can be contracted through blood transfusion. Ten percent of the respondents answered that bisexual people are eligible to donate blood. 40.7% of the donors agreed to check their HIV status through blood donation. Majority of the donors (60.7%) agreed that the donors’ blood is safe if the screening test is negative. Whereas, 33.9% of the donors disagreed that they shall be responsible if their blood causes infection.
Conclusion: Several knowledge gaps and inappropriate perception among the respondents were identified and these might affect the safety of the blood products. Targeted measures should be taken to rectify donors’ knowledge and perception in order to minimise inappropriate blood donor behaviours and reduce unsafe blood products.
Introduction: The east coast hospitals of Malaysia are regularly stricken by flood disaster and nurses make up the majority of frontline responders in disaster. So, they should equip themselves with knowledge and skills related to disaster management. The objective of this study was to explore the factors associated with attitude and practice in disaster management among critical care nurses in the east coast hospitals of Malaysia. Methods: This was a quanti- tative study with a descriptive cross-sectional study design that were involved 250 critical care nurses from the east coast hospitals of Malaysia by used stratified random sampling method. Data were collected by using a validated questionnaire. Multiple logistic regression analysis was used to determine the factors associated with attitude and practice in disaster management. Results: A majority of the critical care nurses had a positive attitude (92.4%, n=231) and adequate practice (80%, n= 200) in disaster management. Among the selected factors studied, attending disaster training/ education was significantly associated with attitude (AOR 4.23, 95% CI: 1.474, 12.144, p = 0.007) and practice (AOR 4.203, 95% CI: 2.102, 8.402, p = 0.000). Disaster response experience had a significant association with practice (AOR 2.697, 95% CI: 1.122, 6.479, p = 0.027) but no significant association with attitude. Level of education, years of service and workplace showed no significant association with attitude and practice in disaster management. Conclusion: This study revealed that disaster training/ education was one of the factors that would ensure positive attitude and adequate practice in disaster management among critical care nurses in the east coast hospitals of Malaysia. Therefore, it is recommended for disaster management programme to be included in continu- ing education training for critical care nurses to ensure them to be well-prepared and respond competently when disaster happen.
Introduction: Increase in antibiotic resistance (ABR) worldwide, specifically in developing countries, requires the need to pay attention to self-medicated antibiotics, perception and attitude of ABR. Self-medication on antibiotics practices have a major pitfall, which is that users do not follow a prescribed course of drug and may usually stop the drug regimen once they feeling better. The spread of ABR is known to be associated with inadequate dosing, and incomplete courses which increases the actual cost of treating illnesses and social burden. This research is motivated by the alarming spread of ABR in Malaysia, the paucity of data on self-medication with antibiotics, and the alarming rate of pharmacy or drug stores that sell antibiotics and prescription-only medicines that are unauthorized to do so. Thus, the study has been done to observe the pattern of antibiotics usage of undergraduate students in a public uni- versity. Methods: Quantitative study with cross-sectional study have been chosen in this study and the target sample is localUniversiti Malaysia Sarawak(UNIMAS) undergraduate students with use of convenience sampling method. Besides, data collection has been done at main library (Centre for Academic Information Services)of UNIMASand students pavilion, UNIMAS by using the fully English online and hardcopy self-administered questionnaire adapted from previous study. Then, the data collected has been analysed by using SPSS Version 22. Results: In this study, 30.5% out of 403respondents have admitted that have taken antibiotics within 6 months and common reason of taking antibiotics given are fever, respiratory tract infection, and pain. Besides, there are 36% of respondents are not compliance to their antibiotics once prescribed with reason of already felt better and healed from the illness. More than 50% of the respondents are believed that antibiotics can treat the viral infection and work on the cold or coughs. For the attitude’s aspect, more than 60% of the respondents are expecting the doctor to prescribed them antibiotics when they are having cold symptoms and 49.9% will take antibiotics when they get cold to help them recover more quickly. Conclusion: This study has showed that there about a quarter of respondents (36%) still using antibiotics in improper method of consumption. Besides, some of the respondents have misunderstanding perception toward anti- biotics and bad attitudes on compliance toward the antibiotics. Thus, this problem from the young adult population could contributes to the increasing trend of antibiotics resistance in Malaysia.
Introduction: Collaborative working culture is an important milestone to be inculcated in a hospital setting. In the process of preparation for the upcoming teaching hospital of Universiti Malaysia Sabah (HUMS), the organisational value of innovative, collaborative, compassionate, empowering, and sustainable needs to be inculcated to the both management and clinical staffs. The objective of this study was to assess the efficacy of a collaborative practise workshop in staff. Methods: A two days experiential learning workshop was conducted to deliver and inculcate the organisational value of HUMS to 32 existing and newly recruited healthcare professionals, which include doctor, nurses, assistant medical officer, dental assistant, pharmacist, and radiographer. The topics consisted of principles of collaborative practice, skill of validation, feedback-giving method, approach for value identification and goal setting, reflective practice, public communication during crisis, shared decision making, and organisational problem solving. Different delivery methods include round table discussion, role play, and group work were used. Innovative real time practice of giving feedback to the management was performed directly to the hospital chief executive officer and chief clinical officer. Results: Immediate feedback from the participants found that the candidates found the course was enriching and it helped them to develop an alternative perspective on how to get work done. The staffs expressed their idea, concern, and expectation more openly with the method learned using what they had learnt. The limitation included the challenge of transition from previous working culture to new environment without further supervision. Conclusions: Further systematic evaluation using more detailed assessment tool is needed to understand the long term efficiency and translatability of the learning outcomes into clinical practice once the hospital is ready.