Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia

Background: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population.Objective: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area.Methods: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis.Results: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015).Conclusion: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection

Prevalence of lipohypertrophy in insulin-treated type 2 diabetes mellitus

Introduction: Lipohypertrophy is one of the most common complications of insulin injection. Early detection of lipo¬hypertrophy is very important to prevent the risk of hyperglycemia or hypoglycemia, arisen due to inconsistencies in absorption of insulin. The purpose of this study is to determine the prevalence of lipohyperthrophy in insulin-treated type 2 Diabetes Mellitus. Methods: This is a quantitative descriptive study which was carried out from June to August 2017 in one of tertiary hospital in Sabah. Participants were recruited via purposive convenience sampling. This study was divided into 2 parts which includes questionnaire survey and examination of lipohyperthrophy based on inspec¬tion and palpation techniques. Study participants were patients with type 2 Diabetes Mellitus and on insulin injection more than 3 months. The finding of the injection site examination recorded as “presence” and “not presence” based on the features of lipohyperthrophy. The features of lipohyperthrophy include a palpable lump, swelling of fatty tissue around the subcutaneous insulin injection site, thickened ‘rubbery’ swelling of tissue that is soft and firm, and less pain sensation. Respondent who have one or more of these features considered as presence of lipohyperthrophy. Results: Out of 130 patients, more than half of respondents (51.5%, n=67) had lipohyperthrophy and 48.5% (n=63) without lipohyperthrophy. The occurrence of lipohyhertrophy is shown to be higher in patients who had a longer duration of insulin injection (p=0.002), Failure of changing needle (p=0.026) and failure of rotation injection site (p=0.017) at each time of injection. Conclusion: The high prevalence of lipohypertrophy shown in this study high¬lights the need for prevention strategies, which include regular assessment for the presence of lipohypertrophy and health education on insulin injection. Health education should emphasize on self-assessment of lipohypertrophy, and the importance of right injection techniques

Translation, cross-cultural adaptation and validation of the revised-skin management needs assessment checklist questionnaire in Malay language

Pressure injury (PI) related knowledge can be used as an outcome indicator of a PI education program. In Malaysia, no scale has been translated and validated for measuring PI-related knowledge among patients with a PI. The purpose of this study was to cross-culturally adapt, translate and determine the validity and reliability of the Malay version of the revised-Skin Management Need Assessment Checklist (revised-SMnac). The instrument was initially written in English and translated into the Malay language. The internal consistency, construct validity, and test-retest reliability were examined after the item and scale's cross-cultural equivalence and content validity were evaluated. Construct validity was determined through the administration of the instrument amongst 170 hospitalised patients with a PI. Content validity index (CVI) was further determined through validation by a panel of five wound care experts. The instrument's stability was determined by the test-retest model with a two-week interval. The content validity of the item-CVI (I-CVI) was >79%, indicating that all 17-items were appropriate, while the scale-CVI (S-CVI) of >0.83 indicated an acceptable scale. The Cronbach's Alpha was .994 indicated good internal consistency. Test-retest showed a good intra-class correlation coefficient, ICC = 0.955 with 95% CI [0.992–0.996]. The Malay version of the revised-SMnac demonstrated to be a valid and reliable tool to measure PI-related knowledge among the Malay-speaking patient population in Malaysia. The tool is recommended for use to measure the effectiveness of education programs related to PI care in future studies

Infusion phlebitis assessment method used in paediatric setting: a systematic review of literature

Phlebitis may localise to the insertion site or travel along the vein. The risk of phlebitis is higher in children as they have thin and weak blood vessels and move continuously due to the pain associated with insertion. Therefore, regular assessment of the risk of developing phlebitis is crucial. This review aimed to identify infusion phlebitis assessment tool used in the paediatric setting. Methods: Electronic databases used were Scopus, ProQuest, ScienceDirect, and Google Scholar. A total of ten studies which assess the development of infusion phlebitis on hospitalised children included in this reviewed. Study findings were discussed and concluded with a recommendation for clinical practice and future studies. Results: Phlebitis development rate was the primary outcome measures in ten studies. Of ten studies, six provided no actual definition of phlebitis. Eight reported phlebitis incidence and/or severity, eight used a scale and two used a definition alone in assessing the development of phlebitis. This review identified five different phlebitis assessment scales. Conclusion: Although there are applicable phlebitis scales can be used for paediatric setting, Limited studies have been conducted on infusion phlebitis assessment method in children. Therefore, it is suggested that more studies and vigorous test needed to identify applicable assessment tools in paediatric setting

Autism: Awareness and Perception among Malaysian Nursing Students in Sabah

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. According to the 2017 survey by the Ministry of Health Malaysia, children between the ages of 18 to 26 months showed ASD occurs approximately 1.6 in1000 children. In Sabah, 400 autistic children had been registered under Sabah Autism Society (SAS). The increasing prevalence of ASD had become a major concern not only to the parents but to the community. A correct understanding and perception about ASD are crucial especially to the nursing profession as they must be able to educate caregiver on how to manage patients with ASD. Methods: This is a quantitative study using a cross-sectional approach. The respondents are all nursing students in Sabah. The type of sampling is purposive, which is using snowball sampling methods. Research instruments were developed and distributed to all nursing colleges in Sabah. Results: A total of 115 students responded. The majority of age is within range of 18–20 years old and female students. Fifty percents (50%) respondents perceived that of autism is a socio-emotional and neuro-developmental disorder with a non-verbal behaviors’ impairment, curable disorder with proper treatment. More than fifty percent (50%) disagree that autistic child does not want friends and equivalent stand on the statement about autistic child can live independently. Ninety five percent (90%) agree that social media plays an important platform to deliver facts about autism, and health care provider remains as a key role to increase the level of awareness to the community. Conclusion: Results of this study revealed that nursing students in Sabah have a good awareness and perception towards autistic disorder. Nursing students in Sabah agree that social media plays a vital part to increase the level of awareness and perception

The usage of cosmetic product containing skin-lightening ingredients among female nursing students in Sabah, Malaysia

Rooted form the ancient times, having a white and a delicate skin has been a dream of all women as it is perceived as a perfect beauty. Due to this high desideratum, the global beauty industry had taken an advantage to this target group promising an instant white skin for as early as three days. Global industry analysts (GIA) pre¬dicted that this year 2020 the global market for skin lighteners will reach $23 billion. Despite the effectiveness of using skin-lightening, some had reported of having adverse effect including dermatological as well as neurological. Methods: This is a quantitative study using descriptive analysis approach to all nursing students in Sabah. The type of sampling is using snowball sampling methods. A questionnaire was developed and distributed to all nursing colleges in Sabah. Results: A total of 161 nursing students responded. Based on this study, most of students start are using cos¬metic product in the age of15years old. Using an open-ended question, the top three cosmetic products containing skin-lightening ingredients use by students are Safi(27.9%), Garnier (25.5%)and Simple(16.1.%). Majority experience acne (47.5%) and skin irritation (18.8%)after using cosmetic products containing skin-lightening ingredients while 36.6% did not experience any skin problem. It is about80% concern about safety when choosing skin care contain skin-lightening ingredients,76.9% will make an effort to read leaflet provided prior to purchasing, 69.4% aware about the list of dangerous ingredients in choosing skin care contain skin-lightening ingredients, 78.1% aware about its side effect. Conclusion: The outcome of this preliminary study lead to the conclusion that nursing students in Sa¬bah are aware that using a cosmetic product contain skin-lightening ingredient is harmful for them

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Factors Influencing Sense Of Belongingness In Clinical Area Among Malaysian Nursing Students

This is a cross sectional research comprising 302 nursing students which were recruited via convenience sampling. The research tool that was used to measure sense of belonging was adapted from BES-CPE questionnaire by Levett-Jones (2017). This is a modified BES-CPE 15-item self-report online questionnaire which had been modified with permission from the author

Dataset on nurses' knowledge, attitude and practice in pressure injury prevention at Sabah, Malaysia

Pressure injuries are a significant problem in healthcare, and understanding the knowledge and practices of nurses in this area is critical to improving patient outcomes. This article presents dataset concerning a survey conducted to assess the knowledge, attitudes, and practices of pressure injury prevention and care among nurses in public hospitals in the West Coast division of Sabah, Malaysia. The study involved 448 nurses who completed a structured questionnaire between April and December 2021, using the Malay version of the Pieper-Zulkowski-Pressure Ulcer Knowledge Test (PZ-PUKT) 2016 questionnaire. The questionnaire included socio-demographic information and three outcome measures related to pressure injury prevention. Quantitative descriptive statistical analysis was used to analyze the survey results. The data suggest that this survey provides insights into nurses' knowledge, attitudes, and practices regarding pressure injury prevention and could inform the development of interventions to improve the prevention and management of pressure injuries in public hospitals