Effect of early clinical skills teaching on 3rd year medical students' learning: The student perspective

AbstractObjectivesThe main purpose of the early introduction of Clinical Skills Learning (CSL) to pre-clinical years is to allow medical students to gain experience in clinical examination skills, basic medical procedures, history-taking and clinical communication. The objective of this study was to determine the effectiveness of the early teaching of clinical skills in preparing medical students for their clinical years.MethodsA validated questionnaire assessing the value of CSL on students in their first clinical year was distributed to 3rd year medical students. The questionnaire consisted of 8 items with a five-point Likert scale and one open-ended question.ResultsThe response rate to the questionnaire was approximately 62%. Nearly 97 (70.8%) students suggested that CSL was a favourable teaching strategy. A high percentage of students (90.5%) agreed that CSL was a useful pre-clinical module to prepare them for their clinical years. The students gave positive feedback on the teaching of history-taking and physical examination, exposure to the hospital environment and acquisition of communication skills with supervisors and patients. No student perceived the CSL module as poor.ConclusionsEarly CSL was well-perceived by students in preparing them for their clinical years. CSL is a vital part of the pre-clinical curriculum and should be further enriched with frequent hospital visits to enhance students' confidence level and performance when interacting with patients during their clinical years

Relationship between the learning styles preferences and academic achievement

The individual learning differences that have been much explored relate to differences in personality, learning styles, strategies and conceptual of learning. This article studies the learning style profile exhibited by students towards the academic achievement in Malaysian Polytechnic. The relationship between learning styles of Polytechnic students and their academic achievement based on VARK learning styles model. The target population was international business students of Malaysian Polytechnic. By means of randomly sampling method, 103 students were selected as sample of research. By descriptive - survey research method and a questionnaire adapted from VARK Learning Style Index, required data were collected. According to the results, no significantly difference between learning style and academic achievement of students. Students academic achievement was quite similar to their individual learning styles. These facts reveal that each learning style has its own strengths and weaknesses

Diversity and ecology of araceae in the water catchment area of Ulu Sat, Kelantan, Peninsular Malaysia

Araceae or aroid is familiarly known as keladi to the locals. The purpose of this study is to assess the diversity and ecology of Araceae in the Water Catchment Area of Ulu Sat, Kelantan, Peninsular Malaysia. The random sampling method was applied. A total of 26 species from 13 genera of Araceae were recorded from the water catchment area of Ulu Sat, Machang, Kelantan, Peninsular Malaysia. This represents about 18.6% out of an estimated 140 species and 46.2% of the 28 genera of Araceae reported for Peninsular Malaysia. The result also shows that 24 species or 92.3% of the collection are the common Araceae species found in lowland dipterocarp forest in Peninsular Malaysia. However, the collection include the species recently recorded, Aglaonema cochinchinense Engl. and the endemic species, Alocasia puber (Hassk.) Schott for Peninsular Malaysia. The paper will also discuss the distribution and ecology of some important Araceae collected from this area

One Parameter Composite Semigroups of Linear Bounded Operators in Strong Operator Topology of Schatten Class Cp

For semigroups of linear bounded operators on Hilbert spaces, the problem of being in Cp , 0 Keyword

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Impact resistance study on rigid polyurethane foam

Polyurethane foam was synthesizes generally using isocyanate and polyol that already mix with the surfactant or catalyst as to aid polymer processing and modify properties of the polymer. Polyurethane can be divided to two types which are flexible foam and rigid foam. Usually, the flexible foam will be used in furniture industry to produce soft furniture cushioning and bedding. Rigid foam generally used for composite structured component and insulation. Main focus of this research is to produce a prediction assessment against penetration resistance of rigid polyurethane foam under specific dynamic load. Evaluation is by using analytical prediction method to evaluate the depth of penetration and energy absorption. The fabricated rigid polyurethane foam was undergoing compression test to obtain its mechanical properties and impact test to verify the prediction model with two significant measurements concerned, impact energy and the penetration depth leave by impactor. The impact speed was set up at 1.5 m/s, 1.7 m/s and 2 m/s. Results of experiment shows variations for depth of penetration and energy absorption to the predicted value from the analytical model. This variation is caused by the specimen’s rigidity disordered during the specimen producing process

Natural fiber-reinforced polycaprolactone green and hybrid biocomposites for various advanced applications

Recent developments within the topic of biomaterials has taken hold of researchers due to the mounting concern of current environmental pollution as well as scarcity resources. Amongst all compatible biomaterials, polycaprolactone (PCL) is deemed to be a great potential biomaterial, especially to the tissue engineering sector, due to its advantages, including its biocompatibility and low bioactivity exhibition. The commercialization of PCL is deemed as infant technology despite of all its advantages. This contributed to the disadvantages of PCL, including expensive, toxic, and complex. Therefore, the shift towards the utilization of PCL as an alternative biomaterial in the development of biocomposites has been exponentially increased in recent years. PCL-based biocomposites are unique and versatile technology equipped with several importance features. In addition, the understanding on the properties of PCL and its blend is vital as it is influenced by the application of biocomposites. The superior characteristics of PCL-based green and hybrid biocomposites has expanded their applications, such as in the biomedical field, as well as in tissue engineering and medical implants. Thus, this review is aimed to critically discuss the characteristics of PCL-based biocomposites, which cover each mechanical and thermal properties and their importance towards several applications. The emergence of nanomaterials as reinforcement agent in PCL-based biocomposites was also a tackled issue within this review. On the whole, recent developments of PCL as a potential biomaterial in recent applications is reviewed