A survey on knowledge, attitude and confidence level of adult cardiopulmonary resuscitation among junior doctors in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. Kota Bharu, Kelantan

In hospital, junior doctors are often the first to initiate resuscitation attempts. Therefore it is important that they have adequate knowledge, positive attitude and good confidence level in managing cardiac arrests according to the current guidelines for resuscitation. Previous studies have shown poor levels of resuscitation training and knowledge among junior doctors. In addition their self reported clinical skills in managing emergency situation are low, highly variable and do not increase during their first years after graduation. However it remains to be proven whether these results of research mainly from other countries are applicable to our local population. There is currently lack of CPR research especially among junior doctors in Malaysia. The aims of this study were to determine the level of knowledge, attitude and confidence of junior doctors in HUSM and HRPZII and also to describe the factors that influence it. This study also serves as a starting point to hopefully create a database that other centers in the nation will be able to add on to. This is cross-sectional study using convenient sample. A questionnaire was design based on AHA Guidelines 2005 and review relevant literature. It was edited by two emergency physicians and pre-test was conducted in HUSM to validate and test the reliability of the questionnaire. All junior doctors in HUSM and HRPZII were included in this study. The study was conducted from October till December 2008. Questionnaires were circulated with help from representative from each hospital. It was anonymous and no time limit. The forms were then collected and coded according to the hospital and checked to confirm the doctors had trained three years and below. Statistical analysis was used using software SPSS version 12.0.1 A total of 70 junior doctors were analyzed. Average age was 26.9 years and 68.6% already in practice less than one year. 68.6% of doctors received basic resuscitation training during internship, out of these 33% had received training in previous one year. Only 11.4% had advanced training in resuscitation. 50% of doctors had attended cardiac arrest cases. However, 60% doctors never performed defibrillation. The mean knowledge score was 68%. The difference between subject variables and knowledge score was statistically not significant. The attitude score was 64.4%. 71.4% of doctors disagree their internship training was adequate and 94.3% agree all junior doctors should have ACLS. The confidence score was 28%. Most of the doctors were not confident being a team leader (85.7%), performing intubation (65.7%), defibrillation (78.6%), administering amiodarone (82.9%) and inserting central venous line (74.3%) during resuscitation. Factors that improved doctor’s confidence in resuscitation were ACLS training, more than a year job experience and completion of rotation in six departments. The resuscitation knowledge was average and most doctors have positive attitude on resuscitation. However self reported confidence doctors. Our result suggest mandatory attainment of BLS during undergraduate and ACLS during internship, increased exposure of real resuscitation situations to improve undergraduate training and regular practical/skill course six monthly

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

Background and purpose: Anxiety is a common condition among acute coronary syndrome patients. This syndrome often goes unrecognised and can persist for months to years, while impacting substantially the quality of life. Therefore, this study aimed to identify the associated factor of anxiety among acute coronary syndrome patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Nur Zahirah. Materials and Methods: This cross-sectional study involved acute coronary syndrome patients admitted to Hospital Universiti Sains Malaysia, Kelantan and Hospital Sultanah Nur Zahirah, Terengganu between August 2014 and May 2015. A standardised questionnaire was developed to interview the respondents. The questionnaire was separated into two sections. The first section comprised the socio-demographic details of the patients. The second section was the validated Depression Anxiety Stress Scale 21 (DASS-21) questionnaire. Simple and multiple logistic regressions were used for analysing the collected data. Results: The mean (standard deviation (SD)) age of acute coronary syndrome patients was 60.4 (11.3) years and 61.2 (10.4) years in Hospital Universiti Sains Malaysia and Hospital Sultanah Nur Zahirah respectively. The majority of acute coronary syndrome patients who experienced anxiety were male (86.3%) with 84.9% of them Malay ethnicity and 85.9% of them married. The factor associated with anxiety among acute coronary syndrome patients was having a history of ischemic heart disease (adjusted odd ratio (OR): 2.20, as well as confidence interval (CI): 1.19, 4.10, p=0.013). Conclusion: It was concluded that anxiety had myriad effects on cardiovascular physiology, which plays an important role in the increased incidence of ischemic events in patients. A screening tool should be created to refine and identify the psychological status of acute coronary syndrome patients, so that early treatment could be given

Adolescent to Adolescent Transformation Program- Nurturing, Enhancing and Promoting Adolescents’ Healthy Habit (ATAP-NEPAH): Curbing Social Problems Among Adolescents in Kelantan Through Peer-To-Peer Health Education

The objectives of ATAP-NEPAH are to enhance and nurture healthy habits among adolescents as well as to empower adolescents in inculcating these healthy habits among them. Health education through peer-to-peer approach is used to instill the knowledge on important areas such as sexual and reproductive health, smoking, substance abuse, illegal street racing (rempit) and mental health. Specific modules were developed by experts (lecturers) in multidisciplinary fields in collaboration with Malaysian Association for Adolescent Health (MAAH), National Population and Family Development Board (NPFDB), Reproductive Health Association of Kelantan (REHAK) and Rhaudatus Sakinah Kelantan. The trained Medical Students Facilitator Team (MSFT) of USM became trainers to secondary one school students. The selected school students were trained by the medical students to become peer educators to their juniors and peers. There was improvement in the readiness level of peer educators, knowledge and attitude towards healthy habits and risky behaviors of other school students after the intervention

A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia.

BACKGROUND We performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia. METHODS This was a prospective intervention study. The primary endpoint of the study was to determine the level of KA about resuscitation after CPR training. The six schools and classes from selected schools were chosen by randomization among the form three and four classes using sealed envelopes. A fully validated questionnaire consisting of three sections (sociodemographic, knowledge and attitude) was given to the pupils before and 2 weeks after the intervention. The intervention group was given a lecture, video show, pamphlet and 1-h practical session on CPR training. The control group received a placebo in order to overcome the learning effect. The maximum scores for the knowledge and attitude sections were 72 and 28, respectively. Repeated measures ANOVA analysis was used for specific objectives to determine the changes in knowledge and attitude level pre- and post-intervention for both study groups. P-values less than 0.05 were taken as significant at 95% confidence intervals. RESULTS The mean (SD) total knowledge scores for the intervention (n = 216) and control (n = 252) groups were 62.43 (13.68) and 62.29 (12.11), respectively (maximum score 72) (p > 0.05). On the other hand, the mean (SD) total attitude scores for the intervention and the control groups were 19.33 (4.51) and 17.85 (4.52), respectively (maximum score 28) (p < 0.001). There were significant differences in mean knowledge and attitude scores between the intervention and control groups with regard to time (pre- and post-intervention). The mean difference in knowledge and attitude scores between both study groups was 8.31 (p < 0.001) and 2.39 (p < 0.001), respectively. CONCLUSIONS The level of knowledge and attitudes of secondary school children was shown to be acceptable prior to the intervention. Furthermore, a brief CPR training program improved their level of knowledge and attitudes significantly as compared to those who had never been trained

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

Background and purpose: Anxiety is a common condition among acute coronary syndrome patients. This syndrome often goes unrecognised and can persist for months to years, while impacting substantially the quality of life. Therefore, this study aimed to identify the associated factor of anxiety among acute coronary syndrome&nbsp;patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Nur Zahirah. Materials and Methods: This cross-sectional study involved acute coronary syndrome&nbsp;patients admitted to Hospital Universiti Sains Malaysia, Kelantan and Hospital Sultanah Nur Zahirah, Terengganu between August 2014 and May 2015. A standardised questionnaire was developed to interview the respondents. The questionnaire was separated into two sections. The first section comprised the socio-demographic details of the patients. The second section was the validated Depression Anxiety Stress Scale 21 (DASS-21) questionnaire. Simple and multiple logistic regressions were used for analysing the collected data. Results: The mean (standard deviation (SD)) age of acute coronary syndrome&nbsp;patients was 60.4 (11.3) years and 61.2 (10.4) years in Hospital Universiti Sains Malaysia and Hospital Sultanah Nur Zahirah respectively. The majority of acute coronary syndrome&nbsp;patients who experienced anxiety were male (86.3%) with 84.9% of them Malay ethnicity and 85.9% of them married. The factor associated with anxiety among acute coronary syndrome&nbsp;patients was having a history of ischemic heart disease (adjusted odd ratio (OR): 2.20, as well as confidence interval (CI): 1.19, 4.10, p=0.013). Conclusion: It was concluded that anxiety had myriad effects on cardiovascular physiology, which plays an important role in the increased incidence of ischemic events in patients. A screening tool should be created to refine and identify the psychological status of acute coronary syndrome&nbsp;patients, so that early treatment could be given

Leptospiral culture without 5'-fluorouracil revealed improved Leptospira isolation from febrile patients in north-eastern Malaysia

Objectives: Isolation of Leptospira by culture represents a definitive growth and confirmation of the disease, yet it is hampered with its nature of slow growth. With slight modification of culture method, the study aims to isolate and characterize Leptospira spp. from patients with acute febrile illness. Methods: A total of 109 blood samples were collected from patients with acute febrile illness that presented at the Emergency Department of Hospital Universiti Sains Malaysia, Malaysia. Clinical samples were subjected to Leptospira IgM Rapid test, microscopic agglutination test (MAT), isolation by culture method, and direct real-time PCR test. For leptospiral isolation, the samples (whole blood and deposit from spun plasma) were cultured into modified Ellinghausen McCullough Johnson Harris (EMJH) media with and without 5’-fluorouracil (5-FU). In every culture positive sample, partial 16S rRNA gene sequencing was performed for molecular identification of the isolates. Phylogenetic analysis was carried out to determine the genetic relatedness among the isolates. An inhibition of 5-FU study was performed on Leptospira interrogans serovar Canicola with different concentrations to compare the growth detection of the tested Leptospira with or without 5-FU within 7 days of incubation. Results: Leptospirosis was diagnosed in 14.7% of patients with acute febrile illness. Two Leptospira spp. (n = 2/109, 1.85%) were successfully isolated from whole blood and deposit from spun plasma samples. B004 and B208 samples were positive at day 11 and day 7, respectively, in EMJH media without addition of 5-FU. Sample B004 was identified as Leptospira interrogans and B208 as Leptospira weilli. Phylogenetic analysis confirmed that both of them were within pathogenic group and they were not related. The 5-FU inhibition study revealed that additional of 5-FU at final concentration of 200 µg/mL to EMJH media demonstrated an inhibitory effect on the growth of the tested strain Conclusion: Isolation of Leptospira spp. using EMJH media without addition of 5’-fluorouracil resulted in a better outcome. Two pathogenic Leptospira isolates were successfully cultivated from patients with acute febrile illness that were genetically not related

Factors associated with prehospital delay in acute myocardial infarction in Maldives

Abstract Background Acute myocardial infarction (AMI) is the top cause of death in Maldives. Our study aims to determine the prehospital delay and its associated factors in AMI patients in Maldives. Methods A cross-sectional study was conducted with 127 patients, divided into early (≤ 6 h) and delayed (> 6 h) presenters to the hospital. The data collection for the study was carried out by interviewing AMI patients, focusing on their socio-demographic characteristics, coronary artery disease risk factors, clinical symptoms, situational factors, and behavioral and cognitive responses to symptoms. Results The median onset-to-door time was 230 (IQR 420) minutes. The mean age of AMI patients was 50.9 (SD ± 12.9) years old, and 39.4% of them had delayed presentation to the hospital. Smokers (adj OR = 0.3; 95% CI: 0.1, 0.9; P = 0.047) and those with previous episodes of chest pain or AMI (adj OR = 0.2; 95% CI: 0.03, 0.91; P = 0.038) were significant factors for early presentation to the hospital, while denial of symptoms (adj OR = 29.3; 95% CI: 1.6, 547.2; P = 0.024) and lack of knowledge (adj OR = 7.2; 95% CI: 1.77, 29.43; P = 0.006) led to a delayed decision to seek treatment. Situational factors such as onset at the workplace (adj OR = 5.8; 95% CI: 1.24, 26.83; P = 0.025) had lower odds of delay, whereas referral cases (adj OR = 7.7; 95% CI: 1.9, 30.94; P = 0.004) and use of sea ambulance (adj OR = 11.1; 95% CI: 2.8, 43.8; P = 0.001) were prone to delay in presentation to the hospital. Conclusion Sea ambulance, referral cases, lack of knowledge, and denial of symptoms are significant factors associated with prehospital delay among patients with AMI. Public awareness about the benefits of early presentation and improvement of the means of transportation between islands is suggested to improve emergency cardiac care in the country

A Performance Assessment Study of Different Clinical Samples for Rapid COVID-19 Antigen Diagnosis Tests

Accurate diagnosis to limit the spread of SARS-CoV-2 is crucial for the clinical management of this lethal infection. Recently, many low-cost and easy-to-use rapid test kits (RTK) have been developed in many countries for the massive screening of SARS-CoV-2. Thus, evaluating the accuracy and reliability of an RTK is critical. The current study was conducted on 157 individuals to evaluate the performance accuracy of rapid SARS-CoV-2 antigen detection kits using different clinical samples compared with qRT-PCR results. Nasopharyngeal swabs were collected from patients for qRT-PCR and RTK tests, and then buccal and nasal, and nasal swabs were collected for RTK tests separately. The nasal and buccal swabs showed high sensitivity (98%) and specificity (100%) compared with the qRT-PCR results. Meanwhile, for nasal, the sensitivity was 96% with 98% specificity, and nasopharyngeal swabs showed 98% sensitivity and 94% specificity. Fisher&rsquo;s exact test revealed statistical significance (p &lt; 0.05) between nasopharyngeal, nasal and buccal, and nasal swabs compared with qRT-PCR results. The study concludes that different clinical samples used for the rapid diagnosis of SARS-CoV-2 showed high sensitivities and specificities compared with qRT-PCR. The RTKs using nasal and buccal, nasopharyngeal, and nasal swabs are valuable tools for the early detection of SARS-CoV-2, especially when molecular detections are available with limited access and a high infectivity rate, when the timely detection of virus cases is urgently needed. These types of clinical samples are effective to be used by RTKs for surveillance among community and healthcare workers

Performance Validation of COVID-19 Self-Conduct Buccal and Nasal Swabs RTK-Antigen Diagnostic Kit

The antigen rapid diagnostic test (Ag-RDT) is an immunodiagnostic test that detects the presence of viral proteins (antigens) expressed by the COVID-19 virus in a sample from a patient&rsquo;s respiratory tract. This study focused on evaluating the performance of self-conduct buccal and nasal swabs RTK-antigen test compared to nasopharyngeal swab RTK-based COVID-19 diagnostic assays, Panbio&trade; COVID-19 Ag Rapid Test Device (Nasopharyngeal) (Abbott Rapid Diagnostics Jena GmbH, Jena, Germany) used in hospitals for first-line screening. The sensitivity and specificity of the paired RTK-Ag test in detecting the an-tigen were calculated at 96.4% and 100%, respectively. Fisher exact tests showed the association between nasopharyngeal swabs RTK-Ag assay and buccal-nasal swabs RTK-Ag from ProdetectTM is significant (p-values &lt; 0.001). The result showed that a self-conducted buccal and nasal RTK-antigen rapid test by the patients is comparable to the results obtained from a rapid test device conducted by trained medical personnel using a nasopharyngeal swab