Introduction: Measuring the competence of nurses in spiritual care and their ability to provide spiritual care is im- portant and check the validity and reliability of the instrument is recommended in the literature. Thus, the aim of this study was to validate the translation of the spiritual care competence (SCC) scale to the Malay language version. Methods: Data were collected from staff nurses at the hospital Universiti Sains Malaysia. A total of 270 nurses par- ticipated in the study (female: 92.6%, male: 7.4%), with the mean age of 35 years (SD = 8.4). Spiritual care compe- tence was assessed with the 27-item SCC-M. Standard forward–backward translation was performed to translate the English version of the SCC into the Malay version (SCC-M). All the participants completed the SCC-M. Results: The initial measurement models tested (6-factor models) did not result in a good fit to the data. Subsequent investigation of the confirmatory factor analysis (CFA) results recommended some modifications, including adding correlations between the item residuals within the same latent variable. These modifications resulted in acceptable fit indices for the 6-factor model (RMSEA = .050, CFI = .900, TLI = .885, SRMR = .065). The final measurement models comprised all 27 SCC-M items, which had significant factor loadings of more than .40. The composite reliability was .696-.853 for 6-factors model. These results suggest that the subscales in 6-factor SCC-M model are unique, the factors do not overlap much, and each factor explains different variance than the other factors. Conclusions: The translated version of the SCC-M was valid and reliable for assessing the level of spiritual care competence among hospital nurses in Malaysia.
Introduction: Severe labour pain and dissatisfaction towards supports received from midwives during labour are common experiencesamong parturient mothers. Thesenegative emotional experiences need to be given attention as they are associated with higher acute stress reactions and postpartum depressive symptoms. Therefore, this study examinedthe labour pain and satisfaction toward labour support and their influential factors. Methods: A total of 136 parturient mothersregistered for a labour in the UniversitiKebangsaan Malaysia Medical Centre were included in this studyusing simple random sampling. The mothers had met the eligibility criteria; live and singleton pregnancy, able to communicate in English, Malay or Mandarin. Visual anologue scale and Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BASILIQ) which contained both quantitative and qualitative questions were used to measure the pain and satisfaction level respectively. Descriptive statistics, Spearman correlation, Mann-Whitney and Kruskal-Wallis tests and also content analysis wereutilised to analyse the data. Results: Labour pain was low (Mean=2.24, SD=2.20) and satisfaction toward the labour support was high (Mean=76.9, SD=8.75). Both the pain and satisfaction were not significantly related to each other and also to any of the mothers’ demographic (p > 0.05) and obstetrical data (p > 0.05). However, 32.9% (n=25) out of 76 subjectswho responded to the qualitative questions had highlighted the need of havingfriendly and helpful nurses during their labour.In addition, 56% (n=14) out of 25 subjects who provided additional comments had suggested to include theemotional support to reduce their labour pain, fear and anxiety. Conclusion: Friendly and helpful nurses are part of the emotional support for labour. There- fore, it is recommended that a structured emotional laboursupport should be made availableto parturient mothers. Further research examining the effectiveness of the emotional support on the pain and satisfaction, nevertheless, is warranted.
Introduction: Cardiac rehabilitation is one of the secondary prevention programme to reduce morbidity and mortal- ity in cardiac patients. However, adherence towards this programme is still sub optimal. The objective of this study isto determine the perceived barriers on cardiac rehabilitation programme among cardiac patients and its association with the sociodemographiccharacteristics. Methods: A preliminary study using the Cardiac Rehabilitation Barrier Scale (CRBS) was conducted in a tertiary hospital among 40 patients. The CRBS tool was validated and tested for reliability.Convenience sampling method was used among those who have attended the cardiac rehabilitation pro- gramme. Ethical approval was obtained from the institution ethical committee. There were total of 22 items in the CRBS except for the last item (22nd) being an open-ended item to enable the patients to share their opinion on any other barriers towards attendance to cardiac rehabilitation programme. The 21 items assessed on patients’ opinion on the perceived barriers during their attendance to the cardiac rehabilitation programme in a form of Likert scale. Results: The overall mean (SD) score for the 21 items was 60.70 (8.77) showed that the patients were able to un- derstand gave their best options on the opinions towards CRBS. The highest mean on item 11 on ‘time constraints’ at 3.58 (0.75). Thus, the majority of the patients scored the item “time constraints’ as the highest perceived barrier during attendance in the cardiac rehabilitation programme. The association of the sociodemographic status had sig- nificance difference (p
Introduction: Peripheral Intravenous Cannula (PIVC) placement can cause undesirable effects, such as phlebitis. Poor PIVC care can irritate tunica intima layers of the superficial vein. The incidence of phlebitis had become a national nursing indicator, with a standard of less than 0.9%. The standard care of the patient with intravenous in- cludes a routine PIVC assessment. However, what the assessment should be based on remained unclear. The objec- tive of this study is to assess nurses’ skill in performing PIVC assessment. Methods: This is a descriptive study using an audit-based approach. It is conducted in a pediatric hospital. Nine pediatric wards were identified via stratified sampling methods. A total of 86 registered nurses consented to participate in this study. A validated research instru- ments (α = 0.83), PIVC Assessment Skill (PIVC-AS) checklist is used to audit nurses in performing PIVC assessment. PIVC-AS consists of nine audit criteria (AC), AC1: communication skill, AC2 until AC7: PIVC assessment skill, AC8: documentation skill and AC9: PIVC management. Results: Nurses communication skills to patient as in AC1 shows compliance rate of seventy six percent. The compliance rate can be explained that this study was done in the pedi- atric setting. Participants may skip this communication due to handling with a pediatric patient. More than eighty eight percent nurses comply with AC2 to AC6 which indicated their excellent skill in performing PIVC assessment every shift. However, in the AC7, only sixty seven percent comply to palpate PIVC area for any evidence of venous cord and warmth. Conclusion: This study concludes that communication between nurses and pediatric patients prior to PIVC assessment often missed out by nurses. The palpation techniques also not been carried out as compared to observation technique in pediatrics setting. Palpation technique is crucial to detect ‘warmth to touch’ because it differentiates between the early and medium stage of phlebitis.
Introduction: Simulation is widely practiced as learning strategies in many disciplines including nursing. It is con- sidered an updated technological approach towards providing safe and sound patients care. Thus, this study was conducted to assess the level of knowledge among nursing students using a simulated mannequin for cardiovascular assessment. Methods: This is a cross-sectional study design focusing Year 4 nursing students at Kulliyyah of Nurs- ing, International Islamic University Malaysia (IIUM). A simulation mannequin was used for students performing a cardiovascular assessment. Level of knowledge was tested using an adapted questionnaire. The study was approved by the Kulliyyah of Nursing Postgraduate Research Committee (Ref: IIUM/313/DDAA/20/4/10) and IIUM Research Ethics Committee (Ref: IREC 2018-024). Results: A total of 57 nursing students involved in this study revealing good cardiovascular assessment knowledge. Majority of them reported that simulation exercise is one of the good learning strategies to enhance their capabilities and increase their confidence level. Conclusions: The results from this study could indicate that using technological simulation approach could provide a similar effect in performing cardiovas- cular assessment among nursing student IIUM. Future larger scale is needed including for any other disciplines in nursing to facilitate students’ preparation towards the real clinical setting.
Gene manipulation tools have transformed biomedical research and improved the possibilities of their uses for therapeutic purposes. These tools have aided effective genomic modification in many organisms and have been successfully applied in biomedical engineering, biotechnology and biomedicine. They also shown a potential for therapeutic applications to alleviate genetic and non-genetic diseases. Small interfering RNA (siRNA) and clustered regularly inter-spaced short-palindromic repeat/associated-protein system (CRISPR/Cas) are two of the tools applied in genetic manipulation. This review aims to evaluate the molecular influence of siRNA and CRISPR/Cas as novel tools for genetic manipulations. This review discusses the molecular mechanism of siRNA and CRISPR/Cas, and the advantages and disadvantages of siRNA and CRISPR/Cas. This review also presents comparison between siRNA and CRISPR/Cas as potential tools for gene therapy. siRNA therapeutic applications occur through protein knockout with- out causing damage to cells. siRNA knocks down gene expression at the mRNA level, whereas CRISPR/Cas knocks out gene permanently at the DNA level. Inconclusion, gene manipulation tools have potential for applications that improve therapeutic strategies and plant-derived products, but ethical standards must be established before the clin- ical application of gene editing.
A 42-year-old gentleman presented with left eye pain after accidental contact with Euphorbia lactea sap while gar- dening. At presentation, left eye best-corrected visual acuity (BCVA) was 20/30. Ocular examination revealed left eye conjunctiva congestion and cornea abrasion. Eye symptoms and BCVA deteriorated over 12 hours. Cornea showed diffuse stromal oedema with presence of anterior uveitis. A diagnosis of toxic keratouveitis was made. He was treat- ed with intensive topical steroids, cycloplegics, lubricants, prophylactic antibiotics and oral non-steroidal anti-in- flammatory analgesic. Patient achieved complete resolution two weeks later. We aim to raise awareness among the ophthalmologists to detect and manage these injuries.
A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space oc- cupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to re- duce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.
A 64-year-old Malay gentleman alleged occupational injury when a malfunctioned metal hydraulic door hit on his face while unloading sand from his tipper-truck. Post-trauma, he complained of right eye (RE) pain and total loss of vision. On examination, noted RE visual acuity was unable to be assessed and left eye (LE) was 6/24 with pinhole 6/9. No eyeball could be seen in the right socket with superior orbital rim step deformity and left periorbital haema- toma. Computed tomography scan of the brain and orbit confirmed displaced right eye globe into the right anterior cranial fossa with right and left multiple orbital wall fractures. He then underwent successful right eye globe reposi- tioning. Traumatic orbital roof fracture is a rare condition. Repositioning of the eye globe was done to salvage the eye globe for a cosmetic reason and to avoid localised inflammatory reaction at the anterior cranial fossa.
Combined latissimus dorsi transfer, subscapularis repair and Latarjet surgery is rare and has never been reported. A 35-year-old man with chronic shoulder pain had a long history of instability of his right shoulder. The first episode occurred during a game of touch rugby followed by multiple episodes of subluxation. MRI was done which showed complete tear of the subscapularis anteriorly which was retracted and atrophied indicating a longstanding tear. There was also significant mid substance supraspinatus tendon tear. Patient then underwent two surgeries. The initial sur- gery found the rotator cuff to be irreparable with glenoid bone loss and only acromioplasty with acromioclavicular joint resection were performed. He then had a single stage surgery consisting of latissimus dorsi transfer, Latarjet procedure and subscapularis repair. A two-stage surgery can be avoided, and good results can be obtained provided that the patient undergo correct rehabilitation regime after undergoing a single stage surgery.
Iatrogenic diaphragmatic entry following thoracic surgery is rare with only two cases reported till date. This case reports on a 46-year-old male with persistent pleural sepsis due to right empyema thoracis despite best medical ef- forts. Following a right thoracotomy and decortication, the right diaphragm was inadvertently incised due to dense adhesions between the diaphragm and thickened cortex. To our knowledge, this is the third case reported of iatro- genic diaphragmatic entry following thoracic surgery for empyema thoracis. The pearls from this case report is that any evidence of empyema thoracis involving the lower lobe on imaging should warn the surgeons to be aware of inadvertent entry into the peritoneal cavity, as the diaphragm can be adherent to the cortex trapping the lower lobe.
Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.
Fat density lesions or masses arising from the mesentery are best imaged in Computed Tomography or Magnetic Res- onance Imaging scans. This a case of a 75 year old man who presented with intestinal obstructive symptoms. Urgent computed tomography scan was carried out which revealed a large mesenteric lipoma compressing the small bowel at the level of the jejunal loops. Small bowel obstruction can be due to intrinsic, extrinsic and intraluminal causes. Mesenteric lipomas are uncommon, thus torsion or twisting of the mesenteric lipoma causing intestinal obstruction is exceptionally rare.
Herein is a case report of a 70 years old man with a tenacious benign prostatic hyperplasia (BPH). The aim of this manuscript is to briefly discuss the usage and advantage of EmbozeneTM Microsphere in embolization of the pros- tate arteries in the treatment of failed medical and surgical therapy for BPH.
Introduction: An economical and alternative diabetic wound care product is needed to address the escalating cost of diabetic wound ulcer treatment in Indonesia. Morindac itrifolia or commonly called noni, is a medicinal plant, dietary supplement, and traditional wound care product. This leaves extract contains antioxidant, anti-inflammatory, immune-stimulant, and antimicrobial properties. Trigona honey which is currently used to treat the diabetic wound at Kitamura Wound Specialist Clinic, Pontianak, Indonesia is known for its anti-inflammatory, anti-microbial and anti-proliferative properties. This study aims to compare the effectiveness of Morinda citrifolia leaves extract and Trigona honey in diabetic wound healing. Methods: A quasi-experimental study (a randomized control trial design) was conductedin the clinicon two subjects with diabetic foot ulcers (DFU). Trigona honey and Morinda citrifolia leaves extract packing was done to the ulcer of controlled subject and treatment subject respectively as a primary dressing. DFU assessment was done every 2 days using the MUNGS assessment tool and a wound closure rate for- mula. Wound C&S was analysed using a bacterial count machine. Results: Morinda citrifolia leaves extract was able to promote wound contraction, improved MUNGS score (from 9 to 8), reduced bacteria count significantly (from
8.51 x 105 to 1.00 x 105), reduced the percentage of slough by 70% and increased granulating tissue by 60% after the first application. Whereas, Trigona honey extract showed no wound contraction but improved MUNGS score (from 11 to 7). However, bacteria count was maintained at the lowest level (1.00 x 105), reduce the percentage of slough by 10%, and only increased granulating tissues by 10% after the first application. Conclusion: Both products were able to promote diabetic wound healing but the Morinda citrifolia leaves extract was found to be more effective, thus concludes the potential use of Morinda citrifolia leaves extract in treating DFU.
Introduction: Isolation and border control measures, with home quarantine measures, are essential to stem the spread of the newly emergent novel Covid-19. Such measures are doomed to fail if reliant on traditional isolation methods, which entail small numbers of overworked healthcare staff screening and surveilling large numbers of well individuals who are potential false positives. Innovative method employed by Hospital UMS to overcome these logistics difficulties. Methods: A total of 440 returning China students to UMS were planned for home quarantine measures for 14 days. In the intervening 14 days, groups of ten quarantined individuals were assigned to 1 Manda- rin-speaking medical student liaison officer (LO). LOs performed assessment toolkit for 14 consecutive days virtually via WhatsApp and WeChat and reported back to NCOV central command if any symptoms ensued. Results: 45 China students have been put on home quarantine. Two (2) students with symptoms were monitored virtually till resolution of symptoms. Also, five (5) students with uncontactable phone numbers required tracking down, using var- ious methods eg: retrieval from close contacts through wide-bore virtual search. No cases so far have been positive for NCOV or have required referral to tertiary hospitals. Qualitatively, such methods are a vital public health inter- vention, as task shifting happens to semi-professionals. Hospital UMS first trial of two cherished founding principles: community-based rather than healthcare-facility center healthcare delivery, and judicious use of digital health com- munications, applications, and rudimentary telemedicine. Conclusion: Student-led virtual telemedicine and digital health delivery has potential in public health crises like NCOV, freeing frontline healthcare staff to devote energies to their specialties of screening and treatment. Integration of video and biometrics to incorporate true telemedicine, allowing individuals to be “hospitalized” in a community setting in situations of low risk.
Introduction: Continuous quality improvement of system is essential to improve efficiency of working environ- ment. Limited financial allocation in low resource setting results in the vicious circle of having inadequate money to purchase a new system and print paper documents that are required for the operation of clinic. A staff-initiated system improvement with the name of “PRW UMS Staff Portal” was attempted to break-free from the vicious cycle. Methods: An online system covering different aspects of routine clinical work of healthcare workers was created in Dec 2019 and implemented in Feb 2020 using Google SiteTM by the nurses of a local university community clinic, which included: submission of daily reports of nurses and assistant medical officers, submission of reports of all programmes conducted by the clinic, surveillance of health status of working staffs, announcement and request of working roster, archiving of documents, and medication inventory. The system could only be accessed using official working email for general documents while accesses to sensitive documents were restricted to relevant staffs to pro- tect privacy and confidentiality of information. Qualitative interviews were performed with all nursing staff involved. Results: Qualitative feeling of improvement in coordination of workflow was reported by all 23 staffs working in the clinic in view of the easy access of system using smartphone and computer at workstation. It also reduced the need to move away from the working station in order to access, replenish, or submit the printed documents and reports. Significant amount of paper and printing were saved monthly. Conclusions: Despite positive feedback from the staffs, the system requires further improvement in terms of function and security. Further evaluation on cost-efficiency of the system can be done to promote the system to other universities.
Introduction: Burnout is a psychological syndrome experienced by an individual who is exposed to chronic stress. It is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It is often associ- ated with feelings of hopelessness and difficulties in dealing with work efficiency. As for students, going-through the process of learning is a complex stressful phenomenon causing of poor academic performance. The aim of the study was to explore causes of student nurses’ burnout followed by the intention to leave the program. Methods: This is a cross sectional study with total of 127 respondents selected based on Krejci Morgan (1970) sample size calculation from year 1 till year 3 nursing students. Maslach Burnout Inventory (2016) was used to measure the burnout-self test comprised of emotional exhaustion, depersonalization and personal achievement. Twenty-two (22 items) with 7- points scale measuring responses of “Never (0)” to “Every day (7).” For Part B, three open ended questions applied to the intention of leaving the program. Results: A total of 35% of students had the intention of leaving the nursing program and 54% occurred during the first and second year of the study. Stress and financial struggles triggered the intention of quitting the program and 68% felt the study was breaking them down. Conclusion: Pursuing the program despite of the glitches worth the fights, 99 % of respondents acknowledged that this program is worth their future profession. Through this program they learnt to handle their emotional problem calmly and look after patients and colleague’s problem effectively. Nursing is a field of knowledge of humanities, exclusively in the care of patients and Nursing has been able to educate and transform the society who were insufficient in lives into useful human beings.
Introduction: Studies found that low sleep quality (SQ) is associated with many factors such as health, quality of life (QOL), work or academic performance and co-curriculum activities. Hence, improvement to maintain SQ to en- hance students’ QOL is important. Approximately 43% of Malaysian were unaware of their sleep problem and how it affects their physical and mental health, especially among the younger generation. The study aims to investigate the association between SQ and QOL among undergraduate students in UTAR Sungai Long Campus. Method: A cross-sectional study among 256 undergraduate students recruited by purposive sampling was conducted. The Pitts- burgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life Instruments (WHOQOL-BREF) were administered to evaluate SQ and QOL, respectively. Self-reported demographic data were collected with a structured sociodemographic profile. Associations were evaluated using Spearman’s correlation coefficient, Chi- square test and independence t-test. The level of significance was p< 0.05. Result: Results showed more than one half of students had poor SQ (F=137, 53.5%) and poor QOL (F= 159, 62.1%). All seven PSQI components were significantly associated with at least one QOL domain. Sleep disturbances, sleep latency and daytime dysfunction were correlated with all four QOL domains which are physical health, psychological, social relationships, and envi- ronment. Among the sociodemographic variables, only time travelled from place of stay to campus was associated to SQ (p = 0.04). However, there was no significant association between SQ and the selected sociodemographic vari- ables such as gender, working part-time job, and travel distance from place of stay to campus. Conclusion: Overall, the results from this study showed one half of students suffered from poor SQ and QOL. SQ among undergraduate students is vital in developing good QOL.
Scimitar syndrome is a rare congenital heart defect occurring in 1 to 3 per 100,000 live births. This is a case of a 26 years old lady presenting with episodic fainting spells since the age of 18 years old. She was initially diagnosed with epilepsy until a referral to our centre found a soft splitting of the second heart sound and multiple premature ventricular complexes on ECG. The computed tomography of the pulmonary artery confirmed the diagnosis if Scim- itar syndrome in the presence of anomalous single right pulmonary vein draining into infra-diaphragmatic systemic venous circulation. A corrective open-heart surgery to re-implant the pulmonary vein was performed with excellent clinical outcomes. Therefore, it is crucial for clinicians to embody high index of suspicion of congenital anomaly even in adults presenting with indefinite clinical symptoms. This report also represents the first published case of adult Scimitar syndrome from Malaysia.