Impact of open distance learning professionalism & empowerment courses on clinical nurse practice

Clinical nurse professionalism includes empowerment which is associated with increased nurse satisfaction and improved patient outcomes, both being elements of a healthy work environment. This study aims to compare the academic results of learners in open distance learning (ODL) professionalism course with the purported display of professional behaviour in clinical practice. In addition to demographic data, the survey included in quantifying information on nurses discerning qualities in displaying professionalism and empowerment in their daily nursing practice from their superiors and compared with the learner's academic results upon completion of the course. Data analysis using descriptive statistics involving 73 respondents (63%) from nurse supervisors who rated their nurses. Nurses moral principle is rated highest on acting honestly (65.8%), followed by acting justly (58.9%). On personal integrity, nurses can look after their own wellbeing (56.2%) and act under pressure (58.9%). Their expertise skills showed ability in working and acting independently and being autonomous (50.7%). Their power of making decisions is 52.1% in the clinical area. Nurses who are future-oriented can promote new ideas at the workplace (52.1%), and their sociability level is 50.7% in solving problems responsibly. The above professionalism and empowerment qualities showed a positive trend and relevancy with their academic performance. In conclusion, this study professed to show academic performance of nurses from the course is internalised and visible in their professional behaviour in the clinical area

Blood loss in caesarean section in Hospital Universiti Sains Malaysia (HUSM): estimation by surgeons and anaesthetists in comparison with quantitative measurement and blood parameters assessments.

Background: We compared the visual estimation of blood loss for Caesarean section (CS) by surgeons and anaethetists and their accuracy with relation to years of experience against quantitative measurement. Haemoglobin (Hb) trend after CS were also studied. Methods: 134 patients who underwent CS were included. Visual estimations were reported by surgeons and anaesthetists. The blood volume in collection bottle and disposable items were quantified. Hb levels pre-CS followed by 1 hour and 24 hours post CS were taken. Data were tested by Reliability Testing, Independent T-Test, Pearson’s Correlation and Multiple Linear Regressions where P <0.05 is considered significant. Results: There were strong correlation between surgeon’s and anaesthetist’s estimations of blood loss and quantitative measurement with Intraclass Correlation Coefficient of r = 0.828 and r = 0.805, P <0.001. Surgeons’ accuracy in estimating blood loss has no significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.053. Anaesthetists’ accuracy in estimating blood loss has significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.038. There was moderate negative correlation in between percentage blood loss and Delta Hb 1 hour post CS, P <0.001. Percentage blood loss, intraoperative fluid administration and patient previous scars were strong predictors for Delta Hb 1 hour post CS with P < 0.05. Conclusions: Estimation blood loss for CS by surgeons and anaesthetists in HUSM correlates with quantitative measurement. Drop in Hb post CS correlates with percentage blood loss. Prediction of Delta Hb 1 hour and 24 hours post CS can be a useful tool in helping doctors in managing patient

A comparative study of dexmedetomidine and propofol for sedation in the cardiothoracic intensive care unit

Introduction and Objectives: The intensive care unit (ICU) is an uncomfortable and stressful environment for patients. The use of adequate sedation and analgesia is important to reduce stress to patients. The aim of this study was to compare a relatively new sedative agent, dexmedetomidine to current sedative agent used, propofol in the provision of sedation and analgesia, their effects on haemodynamic and respiratory parameters and cost involved on post open heart surgery patients. Materials and Methods: A prospective, randomized single-blinded trial was conducted on post open heart surgery patients in the ICU of the Hospital Universiti Sains Malaysia (HUSM). Thirty two patients were randomized to dexmedetomidine or propofol groups. Analgesic requirement, haemodynamic and respiratory parameters, and extubation time were measured and compared. Mean rate of infusion to achieve adequate sedation were used to calculate the cost involved in the use of these two agents. Results: Patients sedated with dexmedetomidine required significantly lower dose of morphine compared to propofol [mean (sd): 12.80 (2.61) versus 15.86 (1.87) mg/kg/min, p=0.00]. Mean heart rate was also significantly lower in dexmedetomidine group compared to propofol group [mean (CI): 74.48 (70.38,78.59) versus 83.85 (79.61,88.09) per minutes, p=0.00]. However there were no significant differences in the other parameters between the two groups. Cost involved the use of dexmedetomidine was slightly higher compared to propofol (RM 9.57 versus RM8.94 per hour). Discussion and Conclusions: Dexmedetomidine is comparable to propofol in the provision of sedation, and its effect on haemodynamic and respiratory parameters. However it has added advantages in the provision of analgesia, and caused a significant reduction in heart rate. This is beneficial in these patients by reducing myocardial oxygen demand, and hence subsequent ischaemia and infarction. However, further larger studies are needed to evaluate the effect of dexmedetomidine on perioperative cardiac morbidity and mortality

Predicting haemoglobin level within 6 hours and after 24 hours after a caesarean section: are there such formulas to calculate them?

Background: We measured Haemoglobin (Hb) levels within 6 hours and after 24 hours in 134 Caesarean Section cases in Hospital Universiti Sains Malaysia in 2017. Methods: All blood loss from participants were measured gravimetrically and calculated after dry weights from the disposables and collecting bottles are excluded. Hb levels pre-CS followed by Hb within 6 hours and 24 hours post CS were taken.Data were tested by Multiple Linear Regressions where P <0.05 is considered significant. Results: Percentage blood loss, intraoperative fluid administration and patient previous scars were strong predictors for Delta Hb within 6 hours post CS and with exclusion of previous scar in Delta Hb after 24 hours post CS with P <0.05.Formula for Delta Hb within 6 hours post CS = 0.869 + (-0.055 x Percentage Blood Loss (%)) + (-0.001 x Fluid given intraoperatively (mls) + (0.205 x Previous scars (n))Formula for Delta Hb after 24 hours post CS = 0.631 + (-0.086 x Percentage Blood Loss (%)) + (-0.001 x Fluid given intraoperatively (mls) Confounders excluded are Body Mass Index (BMI), duration of surgery, total blood volume, estimated liquor, balance fluid given intraoperatively and after 24 hours, and parity. Conclusions: It is possible to estimate blood loss within 6 hours and after 24 hours after CS. The benefits will include maintaining normal Hb level and assessing need for transfusion for post CS

Non-invasive ventilation in a pregnancy with severe pneumonia

Introduction: Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation. Case presentation: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV. Discussion: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients. Conclusion: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester

Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition

Synthesis, crystal structure, spectroscopic characterisation, and photophysical properties of iridium(iii) complex with pyridine-formimidamide ancillary

Two-dimensional MoS2 has been speculated to be the best material to replace graphene due to its peculiar structural-electronic properties. The MoS2 with size smaller than its exciton Bohr radius (ca. 1.61 nm) would favor multi exciton generation upon absorption of photon with sufficient energy, Ephoton ≫ Egap (1.89 eV); which would increase the efficiency of an excitonic solar cell greater than 60%. Despite promising properties of the MoS2, however an excitonic solar cell with high efficiency is yet to be exhibited. In this work, the MoS2 thin films were fabricated using vacuum thermal evaporation technique and characterized. Four objectives have been outlined i.e., to study the effect of heating rate (steady, and rapid) on the (i) morphology, (ii) size, (iii) optoelectronic and (iv) crystal properties of the fabricated thin films. The MoS2 precursor was heated at the rate 2.027 A/s (steady), and 18.75 A/s (rapid), 1.5 × 10−3 Torr, 1.48 A, and 4.58 V. The deposited films later were characterized using Field Emission Scanning Electron Microscope with Energy Dispersive X-ray attachment, photoluminescence spectrometer, UV–vis-NIR spectrometer, and X-ray Diffractometer. The fabricated thin films exhibited nanosphere morphology with different size distributions i.e., wide (steady heating), and narrow (rapid heating). Two hypotheses were made based on the optoelectronic properties i.e., the basic building block of the MoS2 thin film fabricated under steady heating is (i) experiencing stronger quantum confinement effect, and (ii) dominated by nanocrystals which are smaller than that of the rapid heating. Similar energy loss could be expected in both MoS2 thin films i.e., ca. 0.15 to 0.17 eV, indicating the existence of shallow trap states. The MoS2 thin films were dominated by (0 0 2), (0 0 4), and (1 0 6) crystal planes. Therefore, the vacuum thermal evaporation technique would offer materials with unique size, crystal arrangement, and optoelectronic properties upon change of heating rate

The effect of video based mobile learning on students’ writing skill

Mobile learning is the acquisition of any knowledge or skill in the process of learning and teaching through accessing communications and multimedia, such as video, as the main tool and mobile technologies can be used anywhere, anytime. Mobile technology has helped the activity of teaching, especially the teaching of English in secondary schools. It has facilitated learning and accelerated acceptance by students. A study conducted to find out the effects of video-based mobile learning on students’ writing skills in Indonesia examined limits on content and mechanics in writing based on a module used in the English book at Grade 10. The participants of the study comprised 80 students. The data were analyzed using descriptive and inferential statistics including means, standard deviations and t-tests. The video based mobile learning activity conducted has supported teachers in encouraging students to use higher-order thinking skills to solve problems that are relevant to their daily lives. It has allowed students to assess themselves, and they were able to share their learning in the home through mobile learning