A one - year cross-sectional observation study of the acute management of adult mild head injury in the Emergency Department Hospital Universiti Sains Malaysia

Kecederaan Ringan Otak (MHI) merupakan salah satu presentasi yang agak biasa kepada Jabatan Kecemasan. Kebanyakan pesakit dengan MHI akan sembuh dengan sepenuhnya. Akan tetapi, sebifangan kecil pesakit yang mengalami pembekuan darah dalam otak , akan menjadi lebih serius jika tidak dikenalpasti pada awal. Bagi mereka dengan kecederaan otak yang telah menjadi serius, kesudahan dari segi neurologi adalah kurang memuaskan. Mild Head Injury (MHI) is one of the common presentation to Emergency Department. Most MHI patients recover fully but there is a significant proportion of them harbor intracranial hematoma that might deteriorate if the diagnosis is missed. The Neurological outcome of MHI patients are less favorable once deteriorated

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

A comparison between the effectiveness of a gamified approach with the conventional approach in point-of-care ultrasonographic training

Background Although gamification increases user engagement, its effectiveness in point-of-care ultrasonographic training has yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasonographic training as compared to conventional approach. Methods Participants consisting of junior doctors were randomized into either the (1) gamified or the (2) conventional educational approach for ultrasonographic training. Results A total of 31 junior doctors participated in this study (16 participants in gamified arm, 15 in the conventional arm after one participant from the conventional arm dropped out due to work commitment). Two-way mixed ANOVA test showed that there was no statistically significant interaction between the types of educational approach and time of testing (pre-test, post-test, 2 months post-training) for both theoretical knowledge score and practical skills score, with F(2, 58) = 39.6, p < 0.001, partial η2 = 0.4 and F(2, 58) = 3.06, p = 0.06, partial η2 = 0.095, respectively. For theoretical knowledge score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/− 0.70, 95% CI 18.87–21.69) and mean post-test scores (20.27 +/− 0.65, 95% CI 18.94–21.60) were better than the pre-test scores (12.99 +/− 0.50, 95% CI 11.97–14.00) with p-values < 0.001 for both comparisons respectively. Similarly, for practical skill score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/− 0.70, 95% CI 18.87–21.69) and mean post-test scores (20.27 +/− 0.65, 95% CI 18.94–21.60) were also better than the pre-test scores (12.99 +/− 0.50, 95% CI 11.97–14.00) with p-values < 0.001 for both comparisons respectively. Participants in the gamification arm generally perceived the various game elements and game mechanics as useful in contributing and motivating them to learn ultrasonography. Conclusions Gamification approach could be an effective alternative to conventional approach in point-of-care ultrasonographic training

Increased serum levels of interleukin-6 and von Willenbrand Factor in early phase of acute coronary syndrome in a young and multiethnic Malaysian population

Objective Interleukin-6 (IL6; proinflammatory marker), von Willebrand Factor (vWF; endothelial dysfunction marker) and P-selectin ( platelet activation marker), may play important roles in defining the pathogenesis of vulnerable plaques in acute coronary syndrome (ACS). This study aims to investigate the expression and relationship of these markers in early phases of ACS in a young and multiethnic Malaysian population. Design Peripheral whole blood mRNA, and serum levels of IL6, vWF and P-selectin were measured in 22 patients with ACS, and in 28 controls with angiographically significant coronary artery disease without previous ACS events. Venous blood from ACS patients was obtained within 1 h of hospital admission. Results No significant differences of IL6, vWF and P-selectin mRNA levels between ACS and controls were seen. ACS patients had significantly higher serum levels of IL6 and vWF ( p<0.001), compared with controls. P-selectin correlated with IL6 (r=0.697, p=0.003) and vWF (r=0.497, p=0.05) at mRNA levels, indicating a possible association between these three indices of ACS pathogenesis. Conclusions Increased serum levels of IL6 and vWF suggest that inflammation and endothelial dysfunction may play a prominent role in the pathogenesis of the disease during the early phase of ACS

Improving perception and confidence towards bystander cardiopulmonary resuscitation and public access automated external defibrillator program: how does training program help?

Background In conjunction with an automated external defibrillator (AED) placement program at various locations within a public university in Malaysia, a series of structured training programs were conducted. The objectives of this study is to (1) evaluate the effectiveness of a structured training program in improving the perception of the importance of AED and cardiopulmonary resuscitation (CPR), (2) evaluate the confidence of the employees in using an AED and performing bystander CPR, (3) identify the fears and concerns of these employees in using AED and performing CPR, and (4) determine the perception of these employees towards the strategy of the AEDs placed at various locations within the university. Methods In this single-center observational study, a validated questionnaire aimed to assess the university employees’ attitude and confidence in handling AED and performing CPR before (pre-test) and immediately after (post-test) the training program was conducted. Results A total of 184 participants participated in this study. Using the Wilcoxon signed-rank test, the training programs appeared to have improved the perception that “using AED is important for unresponsive victims” (z = 4.32, p < 0.001) and that “AED practice drills should be performed on a regular basis” (z = − 2.41, p = 0.02) as well as increased the confidence to perform CPR (z = − 8.56, p < 0.001), use AED (z = − 8.93, p < 0.001), identify victims with no signs of life (z = − 7.88, p < 0.001), and the willingness to perform CPR and AED without hesitancy (z = − 8.91, p < 0.001). Fears and concerns on performing CPR and using AED also appeared to have been significantly reduced, and the perception on placement strategies of these AEDs was generally positive. Conclusion Using the theory of planned behavior as the explanatory framework, training programs appear to be helpful in improving the perception and the confidence of the participants towards performing CPR and using AED through the promotion of positive attitude, positive societal expectation, and a positive sense of empowerment. But whether this positive effect will translate into actual CPR performance and AED application in a real cardiac arrest is yet to be seen

Development, validation and translation of cardiopulmonary resuscitation and automated external defibrillator training and placement bilingual questionnaire

Objectives This paper describes the development and translation of a questionnaire purported to measure (1) the perception of the placement strategy of automated external defibrillator, (2) the perception on the importance of bystander cardiopulmonary resuscitation and automated external defibrillator (3) the perception on the confidence and willingness to apply these two lifesaving interventions as well as (4) the fears and concerns in applying these two interventions. For construct validation, exploratory factor analysis was performed using principal axis factoring and promax oblique rotation and confirmatory factor analysis performed using partial least square. Results Five factors with eigenvalue > 1 were identified. Pattern matrix analysis showed that all items were loaded into the factors with factor loading > 0.4. One item was subsequently removed as Cronbach’s alpha > 0.9 which indicates redundancy. Confirmatory factor analysis demonstrated acceptable factor loadings except for one item which was subsequently removed. Internal consistency and discriminant validity was deemed acceptable with no significant cross-loading

Implementing blended learning in emergency airway management training: a randomized controlled trial

Background: While emergency airway management training is conventionally conducted via face-to-face learning (F2FL) workshops, there are inherent cost, time, place and manpower limitations in running such workshops. Blended learning (BL) refers to the systematic integration of online and face-to-face learning aimed to facilitate complex thinking skills and flexible participation at a reduced financial, time and manpower cost. This study was conducted to evaluate its effectiveness in emergency airway management training. Methods: A single-center prospective randomised controlled trial involving 30 doctors from Sarawak General Hospital, Malaysia was conducted from September 2016 to February 2017 to compare the effectiveness of BL versus F2FL for emergency airway management training. Participants in the BL arm were given a period of 12 days to go through the online materials in a learning management system while those in the F2FL arm attended a-day of face-to-face lectures (8 h). Participants from both arms then attended a day of hands-on session consisting of simulation skills training with airway manikins. Pre- and post-tests in knowledge and practical skills were administered. E-learning experience and the perception towards BL among participants in the BL arm were also assessed. Results: Significant improvements in post-test scores as compared to pre-test scores were noted for participants in both BL and F2FL arms for knowledge, practical, and total scores. The degree of increment between the BL group and the F2FL arms for all categories were not significantly different (total scores: 35 marks, inter-quartile range (IQR) 15.0 - 41.0 vs. 31 marks, IQR 24.0 - 41.0, p = 0.690; theory scores: 18 marks, IQR 9 - 24 vs. 19 marks, IQR 15 - 20, p = 0.992; practical scores: 11 marks, IQR 5 -18 vs. 10 marks, IQR 9 - 20, p = 0.461 respectively). The overall perception towards BL was positive. Conclusions: Blended learning is as effective as face-to-face learning for emergency airway management training of junior doctors, suggesting that blended learning may be a feasible alternative to face-to-face learning for such skill training in emergency departments. Trial registration: Malaysian National Medical Research NMRR-16-696-30190. Registered 28 April 2016