A randomized controlled trial on the use of budesonide/formoterol (symbicort) as an alternative reliever medication for mild to moderate asthmatic attack in adult patients in Emergency Department, HUSM

This study is done to evaluate the effectiveness of symbicort (a combination of formoterol and budesonide) as an alternative reliever in mild to moderate acute axacerbation of bronchial asthma Patients who fulfilled the criteria of mild or moderate asthmatic attack and agreed to participate in this study were randomly assigned to either nebulized salbutamol or symbicort turbuhaler as the treatment. Objective and clinical parameters such as respiratory mte (RR), oxygen saturation (SP02), peak expiratory flow mte (PEFR) and fraction of exhale nitric oxide (FENO) were recorded before and after treatment. Subjective assessment using visual analog score and 5-point Likert scale were also taken. The patients were reassessed 15 minutes later for need of further treatment After randomization, 17 out of 32 patients were chosen to receive nebulized salbutamol and another 15 patients to receive symbicort. There were significant improvements in respiratory mte (RR), oxygen satumtion (SP02) and PEFR in patients received symbicort turbuhler (p=O.OOI, p=0.027 and p=<O.OOJ respectively). This result is significant in patients receiving nebulized salbutamol as well. When compared between these two groups, no significant difference was demonstmted. In terms of subjective parameters using 'Visual Analog Score' and '5-point Likert Scale' of breathlessness, it also showed that there were no significant difference in patients who received symbicort turbuhaler or nebulized salbutamol. Symbicort has the potential to be used as an alternative treatment for patients with mild to moderate exacerbation of asthma as there were no significant difference in terms of objective and subjective improvements at least for the first 15 minutes

Tailoring Teaching Instructions According to Student’s Different Learning Styles: Are We Hitting the Right Button?

To address the diverse preferred learning styles, one of the oft-cited recommendations for educators is to tailor teaching instructions accordingly. This pedagogy however, lacks scientific evidences. Furthermore, in medical curriculum, tailoring instructions according to preferred learning styles is not pragmatic. This is because different subjects and in different settings matter may be best delivered in specific delivery mode. Furthermore, patients’ presentations are often multi-sensorial. As such, the onus is on the students themselves to adjust the amount of learning efforts they put in according to their preferred or not preferred learning styles

A pilot study on return of spontaneous Circulation among patients with Cardiopulmonary resuscitation performed in Emergency department, Hospital Universiti Sains Malaysia

Cardiopulmonary resuscitation (CPR) is an integral part of routine job prescription for emergcncy medicine doctors. Since the 1950s, the technique of CPR is ever improving. The introduction of the Utstein's style of reporting of outcomes or CPR has H.1l1her enhanced standardized research works in this vital area. The standardization of dctinitions and reporting template has also allowed more meaningful comparison of one study with another. Dcspitc that. there has not been many published works in this area in Malaysia. This pilot study serves to look into the effectiveness of CPR perli.)rmed in Emergcm;y Department (ED), Hospital Univcrsiti Sains Malaysiu (IIUSM). Two end points of this study arc I. whether return of spontaneous circulation (ROSe) achieved regardless of whether the Rose was sustained until admission to ward 2. whcther ROSe aehievcd and sustained until admission to ward. This is also known as survival to admission Methodology This study was conducted us a prospective. observational study. All patients with CPR done in ED. IIUSM were included in this study. The stuJy was undertaken for a period or one yl.:i.lr. from March 2005 to March 2006. <. 'ardiac arrl.:sl cases \\there CPR was nol pcrlilrllll.:J \-vere excluded lhllll the study. A total of 63 cardiac arrest patients were analyzed. Out of these 63 patients, 23 (36.5%) of the 63 patients were categorized as out-or-hospital Arrests (aHA) whereas the other 40 (63.5IVo) patients had an in-hospital Arrest (II-IA). In total. out of these 63 patients, 19 (30.2%) of them had ROSe regardless of whether the Rose was sustained until admission to ward. The other 44 (69.8%) did not achieve ROSe at all. Only 6 patients (9.5%) achieved ROSe until admission to ward (survival to admission) whereas the other 57 patients (90.5%) did not. In the aHA subgroup analysis. ROSe achieved regardless of whether it was sustained until admission to ward is only 17.4% (11=4) and Rose achieved until admission to ward is only 4.3% (n=l). In the lilA subgroup analysis, ROSe achieved regardless of whether it was sustained until admission to ward is slightly better at 37.5% (n~'I5) and ROSe achieved until admission to ward is slightly better at 12.5%) (n~5). The chance of a patient with IliA to achieve Rose regardless of whether the ROSe was sustained until admission to ward wu:; about two times (37S%) higher compared to a patient with OHA (17.4%) (p:-·O.094). Other factors found to be associated with higher chance or survival rate arc early commencement of CPR within 5 minutes. presence or emergency physicians during CPR. the presence or emergency medicine residents during CPR and shockable rhythm as the initial cardiac arrest rhythm.

The 16th international symposium on critical care and emergency medicine 2009

The practice of allowing family members to witness on·goh')gilc:tiye resuscitation has been gaining grounds in many .9evelop~d cquntries since-tfWiSfirit introduced in the early 1990s.ln many Asian countries, the acceptability of ~~~has not been ~~- .. Methods ' ' This Is the ptehrniriary flnll[ng '_!>nn!>ngoirijf \i!lliiil~IY; s~")llj~ded selfadrtliniStered questionnaire ~y frorn l'loVernber 2008 tO NOveoil~f 2IJ09 to look into theilltitua.es of heatthdire~ti>wiltds.a!IOwi~filrnil~ ptiosl!iice l.l'llrlng·resuscltation .. _ ;t=f~~~~~~~t,w;:<?JT~~~·~~~~ergency rnp~J .. ~!II\1UP to. 36 responders or 83.7%1 Perf!·> " ".· .f. i n~·~i9f._PI'PI'S rituals Qr·n.·te._ s, .including.. prayer a.nd ab~ !h..W. ~--iA<Ilvklllal ~ur~ oilost ~mat on~, pjood,otal~ng. sellin~if!travenous cannula should pe. abo wed to be Wit~essed. conclusiOn The.«>nceptofailoWingf•rniiV presence Is not well accepted by our !taffs although most of them agree that they have a right to be around

Safety attitudes, burnout and wellbeing among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study

ABSTRACT Introduction: The COVID-19 pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on safety attitudes among healthcare workers (HCWs) as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. Methods: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: Safety Attitudes Questionnaire (SAQ); Oldenburg Burnout Inventory; and Hospital and Anxiety Depression Scale. We performed multivariate mixed model regression to assess for independent associations with the SAQ Total Percentage Agree Rates (PAR). Results: We obtained 3,163 responses. A SAQ Total PAR of 35.7%, 15.0%, 51.0% and 3.3% was calculated among respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest in respondents from India at 70.9%–85.4% versus 56.3%–63.6%, respectively. Multivariate analyses revealed that meeting burnout and depression thresholds, and shifts lasting ≥ 12 hours were significantly associated with lower SAQ Total PAR. Conclusion: Addressing factors contributing to high burnout and depression, and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities as this pandemic continues

Embracing Big Data in Medical Education in Malaysia: Overcoming Challenges and Seizing Opportunities

The increasing volume of data generated in the medical field presents both opportunities and challenges for medical education in Malaysia. On one hand, the data allows for the development of genomic and precision medicine (1). However, it also raises concerns about data ownership, potential hacking, and the lack of a centralized electronic the local medical record

Attitudes and perceptions of the general Malaysian public regarding family presence during resuscitation.

INTRODUCTION Family presence (FP) during resuscitation is an increasingly favoured trend, as it affords many benefits to the critically ill patient's family members. However, a previously conducted study showed that only 15.8% of surveyed Malaysian healthcare staff supported FP during resuscitation. METHODS This cross-sectional study used a bilingual self-administered questionnaire to examine the attitudes and perceptions of the general Malaysian public toward the presence of family members during resuscitation of their loved ones. The questionnaires were randomly distributed to Malaysians in three different states and in the federal territory of Kuala Lumpur. RESULTS Out of a total of 190 survey forms distributed, 184 responses were included for analysis. Of the 184 respondents, 140 (76.1%) indicated that they favoured FP during resuscitation. The most common reason cited was that FP during resuscitation provides family members with the assurance that everything possible had been done for their loved ones (n = 157, 85.3%). Respondents who had terminal illnesses were more likely to favour FP during resuscitation than those who did not, and this was statistically significant (95.0% vs. 73.8%; p = 0.04). CONCLUSION FP during resuscitation was favoured by a higher percentage of the general Malaysian public as compared to Malaysian healthcare staff. This could be due to differences in concerns regarding the resuscitation process between members of the public and healthcare staff

Types and risk factors of ambulance accidents: A scoping review

Abstract Background: A scoping review was conducted to map out the common research focusses on ambulance accidents, their key findings and some of the major knowledge gaps in this area. Materials and methods: Relevant, peer-reviewed, Englishlanguage articles on land ambulance accidents were independently searched by the authors using the MEDLINE and CINAHL databases. Anecdotal reports, testimonies and stories in trade or popular magazines and other grey literature were excluded. Articles that do not directly address ambulance accidents were also excluded. Additional articles were identified from the reference lists of the selected articles and from Google search engine. Results: From an initial yield of 879 articles, 19 articles were included. Most of these articles were published from 2001 - 2005 (5 articles, 26.3%) and 2006 - 2010 (5 articles, 26.3%). Eighteen articles (78.3%) are original articles (18 articles, 78.3%) and another one article is a review article. Most of these articles focused on (1) the types of collisions and (2) the risk factors of ambulance accidents. Nine risk factors were identified to have contributed to ambulance accidents: (1) driving in urban areas (2) driving on dry road (3) the use of lights & sirens (4) the failure to use restraints (5) driving for emergency use (6) back seating (7) at road intersection (8) driver's previous records of accidents and (9) interfacility transfer. The two most common risk factors studied were (1) the use of lights & sirens and (2) driving at intersection. Conclusions: Most of the above risk factors can be mapped into three categories of risk factors: task-related factors, vehicle-related factors and environment-related factors. The category of risk factors least studied is the category of driver-related factors

Prehospital care in Malaysia: issues and challenges

Prehospital care is defined as the phase of patient care from the point of injury or illness to the place of definitive treatment. As such, it is imperative that the patient is transported to the right place of care within the right time frame via the right mode of transportation by the right personnel. In this article, the authors explore seven components that are essential in the initial stage of any prehospital care system development-the components of manpower, training, communication, transportation, facilities, access to care and coordinated patient record keeping. The authors then address issues and challenges in these seven components within the Malaysian context. Because of geopolitical and logistic differences from one locality with another, it is not possible for a 'one-size-fit-all' solution to these issues and challenges within Malaysia. Ultimately, any effort to develop the prehospital care system should not be a mere stop gap measure, rather, it should address fundamental root problems in order to ensure sustainability and continuity of effort

An open-label randomised controlled trial on the efficacy of adding intranasal fentanyl to intravenous tramadol in patients with moderate to severe pain following acute musculoskeletal injuries.

INTRODUCTION The use of intranasal fentanyl as an alternative type of analgesia has been shown to be effective in paediatric populations and prehospital settings. Studies on the use of intranasal fentanyl in adult patients in emergency settings are limited. METHODS An open-label study was conducted to evaluate the effectiveness of the addition of 1.5 mcg/kg intranasal fentanyl to 2 mg/kg intravenous tramadol (fentanyl + tramadol arm, n = 10) as compared to the administration of 2 mg/kg intravenous tramadol alone (tramadol-only arm, n = 10) in adult patients with moderate to severe pain due to acute musculoskeletal injuries. RESULTS When analysed using the independent t-test, the difference the between the mean visual analog scale scores pre-intervention and ten-minute post-intervention was 29.8 ± 8.4 mm in the fentanyl + tramadol arm and 19.6 ± 9.7 mm in the tramadol-only arm (t[18] = 2.515, p = 0.022, 95% confidence interval 1.68-18.72 mm). A statistically significant, albeit transient, reduction in the ten-minute post-intervention mean arterial pressure was noted in the fentanyl + tramadol arm as compared to the tramadol-only arm (13.35 mmHg vs. 7.65 mmHg; using Mann-Whitney U test with U-value = 21.5, p = 0.029, r = 0.48). There was a higher incidence of transient dizziness ten minutes after intervention among the patients in the fentanyl + tramadol arm. CONCLUSION Although effective, intranasal fentanyl may not be appropriate for routine use in adult patients as it may result in a significant reduction in blood pressure