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Fulltext Global health film club - bringing global health issues and activism to local communities

Nicholas Pang, Jiann Lin Loo

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):50-50.
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Introduction: Global health awareness is sorely lacking in medical curricula and the general public, leading to increasing apathy and decreased levels of volunteerism. Much knowledge about pertinent global health issues is sequestered with academicians and researchers, with little public trickle down. The aim of the study was to increase awareness among Sabahan public about global health issues and promote discussion. Methods: A global health film club was established at community level and discussions about issues and potential individual action points was conducted. Films were screened every month in both UMS and Palliative Care Center Sabah. Global health issues ranging from First World manipulation of HIV/AIDS medication prices, deregulation of medical devices industries, heroin addiction, ADHD drug abuse, and stigma in psychiatry were covered. Public participants’ responses were collected qualitatively. Results: The films largely were well received by participants, with most participants prefer-ring the expose-type films over the more narrative approaches. Films spurred discussion about how foreign or global issues were related to local level, for example unscrupulous sale of medical devices in Malaysian populations and abuse of sleeping medications from local health providers. Also each film screening vastly increased participants’ awareness of pertinent issues, and spurred them to evangelise about said issues to others and take small actions. Conclusion: Global health is a somewhat neglected part of medical and community curricula. Lack of awareness about global health issues reduces the public’s capacity for collective action in exerting pressure on stakeholders, governments, and civil society in taking action. It is hoped such regular global health film screenings at local level brings literacy on urgent public health issues to the people for whom it matters most – the communities where ad-verse global health consequences eventually arise.
Fulltext Peer-led group tele-supervision of clinical psychologists: optimizationof resources – a malaysian case study

Umi Izzatti Saedon, Nicholas Pang Tze Ping, Loo, Jiann Lin

Borneo Journal of Medical Sciences, 2019;14(1):67-71.
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Inaccessibility to clinical supervision is an issue faced by solo clinical psychologist practitioners. Combination use of web-based instant messaging and video call application were tried by 28 clinical psychologists in conducting a peer-led group tele-supervision to address ethical dilemmas, discuss case management, provide technical instruction, explore resistance and analyse countertransference, provide emotional support, and share knowledge and updated guidelines. Despite facing challenges including difficulty in face-to-face session scheduling, limited time for in-depth discussion, internet connection issues, and documentation dilemma, we believe it has potential to influence supervision practice for clinicians working in isolation in rural or remote locations.
Fulltext Assessment of practical science communication skills as a core competency of admission to undergraduate medical programmes: nationwide outcomes and associated factors

Nicholas Pang, Jiann Lin Loo, Yusuf Ibrahim, Pasupuleti Visweswara Rao, Fairrul Kadir, Mohd Saffree Jeffree

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):14-14.
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Introduction: Interprofessional scientific communication skills are an essential part of the medical profession. Mul-tiple research suggests poor interprofessional communication has direct correlations with poor patient outcomes. As part of the inaugural Multiple Mini Interview (MMI) at Universiti Malaysia Sabah, a 5-minute station on science com-munication was introduced, assessed on three domains – logical thinking, communication skills, and general impres-sion. This station featured a panicky nurse calling a doctor to get them to calculate doses of a medication, using only upper primary school-level arithmetic and knowledge of ratios. Methods: 255 candidates, grouped into 3 separate geographical groups – Klang Valley, non-Klang Valley, and Borneo – participated in the MMI featuring a science communication station. Candidates were graded in the abovementioned three domains, and correlations were cal-culated between scores and various sociodemographic factors, with an objective written basic science test, and with overall scores. Also, quantitative analysis was done of the “red flag” comments for candidates deemed unsuitable for the practise of medicine. Results: The average scores for West Malaysia for logical thinking scores were higher than Borneo, with non-Klang Valley scores (4.1) significantly higher than Klang Valley (3.6). Communication scores were also significantly lower in Borneo compared to West Malaysia. General impression scores hence also showed a dis-crepancy between West Malaysian and Bornean scores. There were a total of 8 red flags, with reasons ranging from gross miscalculation with misplaced confidence, to nervous breakdowns while performing calculations. Conclusion: The present study showed that there is a distinct separation of science communication scores between geographic re-gions. Also it illustrates the yawning gap between academic knowledge and “translational” scientific knowledge. The results illustrate the need for medical curricula to boost resilience and translational computational skills in medical graduates who will be working in environments that demand usual abilities under unusual and trying circumstances.
Fulltext Analyses of the effectiveness of Movement Control Order (MCO) in reducing the covid-19 confirmed cases in Malaysia

Ping, Nicholas Pang Tze, Kamu, Assis, Mohd Amiruddin Mohd Kassim, Mun, Ho Chong

JUMMEC, 2020;23(102):16-27.
MyJurnal

The COVID-19 pandemic resulted in 5 consecutive Movement Control Orders (MCOs) in Malaysia in an attempt to flatten the epidemiological curve, with a reduction of cases. This study aims to use statistical analysis to assess whether the decisive public health interventions in the MCO were efficacious. Three statistical tests were employed: Mann-Kendall trend analysis; one way between groups ANOVA; and Pearson correlation test. Results demonstrated significant differences between the second block, MCO 3-5, compared to MCO 1-2. Johor and Selangor states experienced significant increase in early MCO, whereas Sarawak and Selangor states experienced significant decrease by MCO 3-5. The northern border states of Kedah, Perlis and Kelantan, had caseloads stabilised to zero by MCO 4/MCO 5. This study demonstrates that the MCO was effective within the target of twice the two-week incubation period of COVID-19, with cases from community transmission and importation through the air and southern land borders. Selangor and Sarawak had higher cases in early MCO due to situational factors. In conclusion, MCO has been efficacious, with different states attaining different levels of case reduction due to individualised reasons.
Fulltext Inculcating collaborative practice among healthcare professionals: initiative from Hospital Universiti Malaysia Sabah

Jeanny John, Joanne Justin, Dainah Francis, Helen Benedict Lasimbang, Wendy Diana Shoesmith, Loo Jiann Lin, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):8-0.
MyJurnal

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.
Fulltext Widespread pandemic, wide-ranging response: student-led virtual telemedicine and digital community-based healthcare provision in a university healthcare centre in response to coronavirus quarantine measures

Muhammad Syafiq Abdullah, Nicholas Pang, Sharinah Abd Kassim, Flora Aurora AmatUdat, NurZiana Ulkaya, NuraisyahNurullah, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):13-0.
MyJurnal

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.
Fulltext A staff-initiated quality improvement project: from paper to web report

Daphne Clemente, Nurul Amiella Abdullah, ZurianahJusmin Jasmin, Muhammad Syafiq Abdullah, Helen Benedict Lasimbang, Wendy Diana Shoesmith, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):14-0.
MyJurnal

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.
Fulltext A pilot design of a protocol for a university-wide community- based occupational health screening project: HUMS2U

Nicholas Pang, Sofeinah Didora Judip, Jeanny John, Erwani Minin, Noor Rajrinnie Rajak, Luqman Ridha Anwar, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):63-0.
MyJurnal

Introduction: University-wide healthcare programme are difficult to implement without complete protocols. This paper describes a collaborative academia-nursing programme to design a quick, user-friendly primary care screen- ing toolkit, to be used at community level at each faculty in UMS. Methods: A Primary Care Condition Assessment Questionnaire was designed by family medicine physicians, mental health doctors, and public health physicians. The questionnaire was pilot tested in 2 different faculties. The Primary Care Condition Assessment Questionnaire was manualized, and a one-day intervention training programme was administered. Subsequently 19 nurses and assistant medical officers were trained in the questionnaire administration and given concurrent communication skills and collaborative practice training to operate the questionnaire. Qualitative assessments of abilities to perform common primary health assessments were performed. Results: Trained nurses qualitatively felt they were more con- fident to perform primary care screening of common healthcare conditions and were able to deliver advice and refer screen-positive individuals to appropriate referral pathways. Conclusion: Public health programmes like HUMS2U put healthcare into the hands of nurses, allowing task-shifting to adequately trained non-specialist professions, and empowers nurses in basic non-communicable disease training and management. Further research will be performed to assess efficacy of the programme at all 23 faculties and departments of the university.
Fulltext Beginner crisis communication for nurses: an introductory module of Hospital Universiti Malaysia Sabah

Megawanah Mohd Razalee, Prisia Jibin, Sabrina Paul, Muhammad Syafiq Abdullah, Helen Benedict Lasimbang, Wendy Diana Shoesmith, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):65-0.
MyJurnal

Introduction: Crisis communication is an important skill for healthcare professionals, especially during disaster peri- od including the current 2019-nCoV pandemic. Nevertheless, the skill of crisis communication is not commonly an integral part of Malaysian nursing diploma and degree course. Methods: A half days session on how to communicate in the context of crisis was incorporated into an experiential learning workshop to 25 existing and newly recruited nurses together with 7 other healthcare professionals. The topics of nature of disaster, disease outbreak, preparation for disaster, principles and responsibility of crisis communication, preparing statement for press conference, and corporate communication were covered through brief lecture, round table discussion and tabletop simulations. Real time example of 2019-nCoV crisis communication was used to illustrate the skills required in the situation. Results: All participants confirmed that this was the first exposure to hands-on training on crisis communication and enlightening although majority of them were uncertain that they are capable to perform it during the crisis despite the ongoing 2019-nCoV issue in view of their the position that they are holding. Most nursing curriculums focus on clinical theory and clinical skill competency acquisition without addressing the need of learning how to commu- nicate beyond clinical setting in the situation of disaster and panic, which is mostly learned at job. The limitation included the practice in tabletop simulations might not be immediately translatable into real life practice. Conclu- sion: Regular reinforcement through more workshops and incorporation into disaster may potentially be a solution to improve the competency of healthcare professionals in crisis communication. Further assessment on the practice of the participants in performing crisis communication is needed to ensure the competency level has been achieved and to evaluate the efficiency of the workshop delivery method.
Fulltext Ultra Brief Psychological Interventions for COVID-19 Pandemic: Introduction of a Locally-Adapted Brief Intervention for Mental Health and Psychosocial Support Service

Ping NPT, Shoesmith WD, James S, Nor Hadi NM, Yau EKB, Lin LJ

Malays J Med Sci, 2020 Mar;27(2):51-56.
PMID: 32788841 MyJurnal DOI: 10.21315/mjms2020.27.2.6

The ultra-brief psychological interventions (UBPI) was created in 2018 to empower healthcare providers with psychological skills that can be delivered within a short period. Techniques used within UBPI were adopted from a variety of well established psychotherapies and distilled into its core essentials. This enabled practitioners of UBPI to deliver specific psychological skills in the appropriate context to the client within a period of 15-20 min. UBPI was also manualised to standardised training of practitioners. During the novel coronavirus disease of 2019 (COVID-19) pandemic, UBPI was modified to suit the unique psychological demands of the pandemic. This article presents how UBPI was adapted and used with healthcare providers dealing with COVID-19 and also with the public who required psychological first aid (PFA).
Fulltext Psychiatric illness and pregnancy: A literature review

Abdelhafez MA, Ahmed KM, Ahmed NM, Ismail M, Mohd Daud MNB, Ping NPT, et al.

Heliyon, 2023 Nov;9(11):e20958.
PMID: 37954333 DOI: 10.1016/j.heliyon.2023.e20958

BACKGROUND: Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period.
OBJECTIVES: This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies.
METHODS: A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study.
RESULTS: The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes.
CONCLUSIONS: Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.

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