The use of a sprinkler irrigation system is becoming more popular to reduce water
consumption and increase irrigation efficiency. Irrigation uniformity plays an important role in the
performance of the sprinkler irrigation system. The use of low operating pressure instead of high
operating pressure system offer many benefits including energy and water saving. An experimental
study was performed using two systems; a square 12x12 m system and a rectangular 10x12 m system
to investigate irrigation uniformity based on soil moisture content of the sprinkler irrigation system
under low operating pressure. In addition, irrigation uniformity was compared based on water
application and soil moisture content. In this study, different low operating pressures (62, 82, 102 and
122 KPa) were selected. Different nozzle diameters (4, 5, 6 and 7 mm) and different riser heights (0.5,
0.75, and 1.0 m) were also used. The soil moisture content uniformities of 10 min after irrigation are
more dependent on the initial soil moisture content uniformity than any other design factor. It is also
less influenced by water application uniformity.
Background: Reflection on the process of learning is an essential ingredient in transforming novice into expert learners. Learning to compile portfolio encourages reflective skills, which help students to work systemically in translating metacognition into self-regulatory control in order to adjust their action and monitor their learning objectives. Introducing to compile portfolio in the early years of postgraduate training is an effective tool to stimulate students’ reflective abilities. Reflective learners are better motivated than the conventional learners to take the responsibilities as researcher in future. Reflective skills achieve both learning in right direction and learning for whole life. However, use of formal methods of reflective portfolio to monitor the learning objectives is an uncommon practice in postgraduate training, primarily due to intensive time and labor required. Challenged with those constraints in Master’s of Surgery Program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences at Universiti Sains Malaysia, a structured self-reflective portfolio was introduced to determine its feasibility and acceptance among supervisors and trainees. Portfolio was practiced as one of the tool for formative assessment and for making recommendations to certify independent thyroid surgery allowed to practice in future. Methodology: A self-reflective structured portfolio was introduced to monitor the learning objectives in trainees of 2007 cohort, using a model as "mentor-system for authentic and structured learning with self-reflective assessment" (MASSRA). Initially a semi-structured portfolio comprising of 12 items and guidelines to compile a portfolio was followed by a structured format in training of thyroid module in sub-specialty of Head and Neck Surgery. Mentoring was organized by putting one-mentor verses 9 students to provide general pastoral guidance to compile portfolio as two entries a year. Mentors held the counseling session with student twice a year after evaluating the portfolios to monitor their progress. Besides, candidates were also observed for their performance in thyroid surgery during a 4-years training program. Those identified with problems for their level of training were referred to "Joint Committee for Surgical Training" comprising of 3 supervisors from Head and Neck Surgery Sub-specialty and a chairman supposedly the head of the department. 7 randomly selected students were also interviewed for direct feedback to evaluate this model. Result: 28 trainees at different level of their training compiled a self-reflection structured portfolio minimum twice a year with instructional feedback from the mentor, which was used as a tract for their personal development plan (produced by each trainee) for training in thyroid surgery. Initial analysis of portfolio revealed interesting feedback from the trainees reflecting on their knowledge, surgical skills and attitude towards thyroid surgery seen in tables 2-4. Conclusion: Self-reflections about each structured items in portfolio-helped trainees to identify their problems, seek mentors guidance and work systemically to help adjust their actions by revising learning objectives. Though time and labor intensive, portfolio was rated as feasible and practical.
Background: The weekly held clinical pathologic case conference popularly known as CPC provides an effective and regular educational media of collaborative learning for inter-disciplinary exchange of knowledge among the faculty members of an institution. CPC has been routinely practiced for the last two decades in School of medical Sciences (SMS) at Universiti Sains Malaysia (USM). An hour session primarily involves a case presentation hiding the diagnosis followed by discussion on differential diagnosis and floor interaction on interesting clinical cases. It also gives an opportunity to new teaching staff in the institution to experience an in-house practice of presenting the clinical cases; witch can readily be reproduced as a case report for publication. An effort to follow the original format of CPC is comprehended as an essential outcome of this study to keep up the sanctity of CPC as a case method of learning medicine in future. Methodology: A questionnaire-based survey was recently conducted to evaluate the weekly held CPC in SMS. It was a cross sectional survey in which a questionnaire comprising of 23 items was administered to a targeted population of faculty members of School of Medical Sciences. The items in questionnaire were grouped into 5 clusters. All respondents were adequately briefed through a letter addressing the objectives and importance of survey and its appraisal aiming to revamp the CPC guided by the out-come of study. Questionnaires were administered to 240 academic staff, covering > 80% of the target population of 294 faculty members. 159 (66.2%) members of sample population completed the questionnaires. Total non-responses were 81 (33.7%) and item non-responses were 320 (8.7%) Result: All the items in questionnaire were found significant (p 0.016) except those two items related to, observing a difference in preparing for a case presentation verses a formal CPC presentation and its promotion (p 0.556 and 0.197 respectively). It was also established that the major respondents were unaware of the original format of CPC (p 0.003) in which a presenter select and prepares a case, which is discussed with participating faculty members for its differential diagnoses. 51.6% faculty members did not follow the formal CPC format (p 0.016) in their presentations. A lack of awareness about the format of CPC was shown by (61.0%) faculty members (p 0.003). Conclusion : It was concluded that emphasis to discuss the differential diagnosis by a competent discussant was lacking, as presenters did not follow the formal CPC format. It was critically observed that a number of presentations made in this weekly program deviate from the original format adapted by SMS in USM. However, the out-come appraisal of this survey was the pledge shown by the majority faculty members to adapt the guidelines as a reverence to the formal CPC format.
The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.
Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.
The Combined Cleft Clinic at the University Hospital, Kuala Lumpur was organised in 1992. The team consists of Plastic Surgeon, Orthodontists, Speech therapist, Ear, Nose and Throat Surgeon, Audiologist, medical officers and the nurses. We attend the clinic on a regular basis. Specialists from other medical and dental disciplines as well as the members of the Cleft Lip and Palate Association of Malaysia (CLAPAM) do occasionally participate in this set-up.The team members formulate treatment plans for each cleft patient, monitor the patient's growth and development and manage the patient at different stages according to the individual needs. To date, the idea of team approach and an establishment of a centre towards management of cleft patients seem to be the most ideal as the patients are benefiting total treatment and care from various specialists from only one place. The experience of University Hospital as a centre for cleft patients is discussed.
Thyroid enlargement is one of the common surgical presentations in the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM). Among them, benign non-toxic multinodular goiter constitutes one third (30%) of patients who underwent thyroidectomy. Common complications of thyroidectomy include recurrent laryngeal nerve (RLN) injury, hypocalcaemia, and recurrence of the thyroid lesion. Objective & Methods: This is a retrospective study of patients diagnosed with multinodular goiter treated in HUSM between January 1996 and December 2005. A total of 111 patients were studied and 52 of them underwent subtotal thyroidectomy while 59 underwent total thyroidectomy. The outcome in terms of RLN injury, hypocalcaemia and mass recurrence were analyzed. Results: Post operative complications were studied in both groups. Permanent recurrent laryngeal nerve injury occurs in 2.4% (1 case) in subtotal thyroidectomy group compared to total thyroidectomy group (3.6%, 2 cases). Five cases from total thyroidectomy group suffered from permanent hypocalcaemia but none in the other group. 70.7% (29 cases) from subtotal thyroidectomy group have functional remnant of thyroid tissue. Recurrence rate post subtotal thyroidectomy after 5 years is only 4.9% (2 cases). Conclusion: The post operative outcome in patients who underwent subtotal thyroidectomy in HUSM from January 1996 to
December 2005 was better than total thyroidectomy with significant functional thyroid remnant.
Inflammatory pseudotumour (IPT) is a rare benign solid tumor in adults and children. The prevalence, etiology and pathogenesis of this condition are still uncertain. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IPT. Besides, occasionally the nonspecific morphological appearance and clinical presentation of the mass may mimic other more common primary or secondary neoplasms. IPT is commonly encountered in the lung and mediastinum. Other sites include abdomen (liver, pancreas, stomach, omentum), retroperitoneum, pelvis (bladder) and extremities in children. We report a rare case of gastric inflammatory pseudotumour in a 65-year-old female patient. Clinical presentations and its management along with review of literatures are presented.
INTRODUCTION: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.
OBJECTIVE: To study the distribution and role of adenoid mast cells in the causation of OME.
METHODOLOGY: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.
RESULT: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).
CONCLUSION: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.
Oesophageal atresia (EA) and tracheoesophageal fistula (TEF) is one of the congenital anomaly occurring in the newborns with the incidence of 1 in 2500 births seen worldwide. A retrospective review of newborns admitted to Hospital Sultanah Bahiyah (HSB) from 1st January 2000 to 31st December 2009 was done. The objective was to look at the influence of birth weight, time of surgical intervention, presence of other congenital anomaly and presence of preoperative pneumonia to the immediate outcome (mortality) of the surgery. There were 47 patients with oesophageal atresia, out of which 26 (55%) were males and 21 (45%) females. The distribution of patients by race were 34 Malays (72%), 9 Chinese (19%) and 4 Indians (9%). The birth weight of the babies range from 0.8 kg to 4.0 kg and there was a significant association with the outcome of the surgery (p< 0.05). Most of the babies (20) were operated within 24 hours of presentation but there was no significant association to the outcome. 23 (49%) of them were born with congenital malformation and there was a significant association with the outcome of the surgery (p<0.05). Based on the chest roentgenogram, 20 (43%) of them had pneumonia with significant association with the outcome (p<0.05). The mortality rate is 23% and the causes of death were pneumonia (36%), renal failure (18%), cardiac malformation (18%) and multiple congenital malformations (28%). The outcome of EA and TEF is determined mainly by birth weight, congenital malformations and presence of preoperative pneumonia in HSB.
Rectus sheath hematoma (RSH) is a rare clinical entity that has been associated with the use of injectable anticoagulant therapy. Although low molecular weight heparin (LMWH) was proven to have a better safety profile than its predecessor, it is not without its own risk of bleeding. The increase in use of self-injectable LMWH in both in-patient as well as out-patient basis warrants greater awareness among health care providers, patients and caregivers regarding the potential risks and identification of possible complications. We present a fatal case of rectus sheath hematoma in an elderly man that occurred following erroneous technique of Dalteparin injection.
Introduction: Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods: A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft ExcelTM. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results: Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p=
Background: Patients’ satisfaction with their nursing care is an important issue in assessing the quality
of nursing care. In Iran, cancer patients’ satisfaction at teaching hospitals of Tehran City has not been
investigated. Aim: A cross sectional study was conducted to determine the level and identify factors that contributed to patients’ satisfaction in nursing care provided at selected teaching hospitals in Tehran City, Islamic Republic of Iran. Method: A proportional stratified sampling method was used and data were collected via face-to-face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 384 cancer patients aged 14 years and above were selected. Result: The majority of respondents were males (201, 52.4%), age group 45-54 years (102, 26.4%); employed (202, 52.6%) and with a family monthly income of US$200-500 (234, 60.9%).The majority (314, 81.8%) of respondents were hospitalized between 2 to 5 days, and most (204, 54.0%) of them were admitted to teaching hospital B of The University of Medical Science.1 A majority of the respondents (318, 82.8%) was satisfied with the nursing care provided, while the others (66, 17.2%) were not. Generally, most of the respondents were satisfied with the amount of information given by the nurses (294, 76.6%), technical quality (295, 76.8%), interpersonal relationship (371, 96.6%), and physical environment (267, 69.5%). There was a positive significant relationship between patients’ satisfaction and type of hospital ( 2=4.985; df=1; p=0.026, n=384). Using the University’s hospital type was found to be the best predictor for level of satisfaction. Conclusion: Most of the respondents were satisfied with the nursing care. However, the respondents suggested several improvements such as increasing the number of doctors, improving socioenvironment factors in terms of privacy and interpersonal relationship, and improving on the existing facilities. Further research is needed to study in depth the socio-cultural and environment parameters which are relevant to patients’ satisfaction with nursing care.
The purpose of this study was to determine the
DNA yield and quality from different non-invasive
sampling methods and to identify the method which
gave the highest DNA yield. Method: Thirty-eight
volunteers had been recruited in this study where
blood, buccal cells and saliva were collected using
various collection techniques. Buccal cells were
collected by 1) cytobrush and 2) saline mouth rinsing
or “swish”. Meanwhile saliva was collected by passive
drooling method. Upon processing the white blood
cell (WBC), buccal cells and saliva samples, DNA
extraction was performed according to the
manufacturer’s protocol. Quantification and quality
(DNA ratio at A260/A280) of the extracted DNA were
determined using NanoDropND-1000®. T-test was
performed to compare means between DNA obtained
from various collection methods. Results: DNA yields
from buccal cells collected with cytobrush, “swish”,
saliva and WBC (mean ± SD) were (8.2 ± 5.9)ng/μl,
(28.2 ± 14.9)ng/μl, (5.9 ± 9.5)ng/μl and (105.3 ±
75.0)ng/μl respectively. Meanwhile the mean DNA
ratio at A260/A280 for cytobrush, “swish”, saliva and
WBC were 2.3, 2.0, 1.7 and 1.8 respectively. Post hoc
test with Bonferroni correction suggested that DNA
yield from “swish” technique exhibited the least mean
different as compared to the DNA extracted from WBC
(p
Sjörgren’s syndrome is an uncommon chronic autoimmune disorder that affects exocrine glands.
Sialolithiasis is an obstructive salivary gland disease which is also uncommon in the parotid salivary gland.
The existing literature has documented the occurrence of multiple calcifications within the parenchyma of
the parotid glands in patients with Sjörgren’s syndrome. This report describes the first case of right parotid
duct solitary sialolith formation in a 64 year old female patient with Sjörgren’s syndrome. Whether the
salivary stone encountered in this case represents an oral manifestation of Sjörgren’s syndrome or is just
a co-incidental finding was discussed.
The aim of this research is to investigate the mediating role of relationship quality in the relationship between relational benefits and customer citizenship behavior. Data were gathered through a systematic sampling from 334 passengers. A Survey technique was used to collect the data from respondents from multiple airports. Data were analyzed through partial least square structural equation modeling (PLS-SEM) using SmartPLS 3.3. The results of the study reveal that altruistic benefits, confidence, and self-expression benefits have a positive relationship with relationship quality while socialization benefits have a non-significant relationship with relationship quality. Similarly, relationship quality mediates the relationship between altruistic benefits, confidence and self-expression benefits, and customer citizenship behavior while relationship quality does not mediate the relationship between socialization benefits and customer citizenship behavior. This study uncovers the relational benefits and its role in the generation of customer citizenship behavior in the aviation sector and the role of relationship quality that could help managers to cultivate the benefits of customer citizenship behaviors.
This is the first epidemiological survey of mental disorders among children in a Malaysian village. The WHO Research Questionnaire for Children (RQC) was used for initial screening followed by a semistructured interview, the Follow-up Interview for Children (FIC) at its second stage. Diagnosis was obtained by using Rutter's multi-axial classification. The prevalence rates obtained for the diagnostic categories were described in 3 age groups, in accordance with the age of attending school in Malaysia. Of 507 children screened aged 1-15, 6.1% were classified as having a mental disorder.
Food irradiation is a process carried out in order to improve hygienic quality and germination
control, retarding sprouting, also enhancing physical attributes of the food product. In order to
provide for food safety, radiation dosimetry in irradiated foods is required. In present studies
use is made of germanium doped (Ge-doped) optical fibres of various form and dimensions.
The fibres are irradiated using a gamma source irradiator (Gamma Cell 220 Excel), with doses
from 1 kGy up to 10 kGy. For the particular Ge-doped optical fibres, investigation has been
made of linearity with dose, reproducibility, and fading, intercomparisons being made. The
fibres all exhibit TL yields that are linear with dose from 1 kGy up to 10 kGy, exceeding the
dose range of all commercial high dose dosimeters used in the food irradiation industry. In
respect of the flat fibre dosimeters, the mean reproducibility was found to be within 0.53%
to 4.96%, also offering low signal loss (fading), within 13.41% (for fibres of cross-sectional
dimensions 60 x 180 µm) to 20.12% (for fibres of cross-sectional dimensions 200 x 750µm),
after 22 days of storage.
There are various causes of the common peroneal nerve palsy. However, common peroneal nerve palsy caused by ganglia are uncommon. We hereby present a case of a 55-year-old man with a 1 week history of foot drop and swelling in the region of the right leg. Physical examination and nerve conduction study studies confirmed a diagnosis of common peroneal nerve palsy. Magnetic resonance imaging (MRI) revealed a lobulated, elongated cystic-appearing mass anterior to the head of fibula. Surgical decompression of the nerve with removal of the mass was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. Findings on physical examination, nerve conduction study and MRI results of this interesting case are being discussed. We wish to highlight that even a tumour which is benign and within the nerve sheath can cause compression.