The Importance of Theory to Inform Practice – Theorizing the Current Trends of Clinical Teaching: A Narrative Review

Clinical teaching lies at the heart of physicians’ training; however, it is often opportunistic, haphazard, and lacks a theoretical foundation. Medical education is a profession that requires robust scientific methods and an evidence-based approach driven by accountability and patient safety concerns in the healthcare provision nowadays. Learning theories are increasingly applied in the realm of medicine with implications to the quality of teaching and learning in the clinical environment and the professional growth of medical graduates. These theories elucidate the basic tenets ambient to the intricate process of learning and answer some basic questions of how people learn. Educational theories provide a myriad of benefits to the teaching and learning approaches in the clinical environment. It arms teachers with a repertoire of educational tools and sets out principles to justify their use and predict the conditions under which they may likely work. It enables clinicians to design their teaching based on well-developed objectives and robust methods for their evaluation. As such, learners’ capacity to achieve clinical competence is enhanced and their identity formation and other essential attributes of clinical expertise are potentiated. However, it has been reported that learning theories are neither well-articulated in clinical teaching nor educators and clinicians are formally trained on their application in the clinical context. Continuous professional development and faculty training about learning theories are essential to lift their capability to teach effectively in the clinical environment. This article revisited the main learning theories and discusses their application to enhance teaching and learning in the clinical context.  Key words: clinical teaching, educational perspectives, learning theorie

Renal Cell Carcinoma in Young Patients is Associated with Poorer Prognosis

Abstract Introduction: Renal cell carcinoma (RCC) in young patients is uncommon but thought to represent a distinctive clinical entity from older patients with different clinico-pathologic features and outcomes. We evaluated the association of age at the time of diagnosis with pathological staging, histological parameters, disease recurrence and overall survival (OS) following radical or partial nephrectomy for non-metastatic RCC in native kidneys. Materials and Methods: A retrospective review of 316 patients with RCC after nephrectomy at a single institution between January 2001 and June 2008 was performed. Eligible patients included all histologically proven primary non-metastatic RCC treated by radical or partial nephrectomy. They were categorised into group A (≤40 years at diagnosis) and B (>40 years). Differences in clinical parameters were analysed using the Mann Whitney U test. The prognostic potential of age at diagnosis was evaluated using Cox proportional hazards regression. Survival was estimated using the Kaplan Meier method. Results: There were 33 patients in group A and 283 patients in group B. There were more non-clear cell tumours in the younger group (30% vs 14%, P <0.05). No statistical differences were found in the stage and grade of both groups. At a median follow-up time of 41 months, the younger group had a higher metastatic rate (18% vs 10.5%, P <0.05), lower 5-year cancer-specifi c survival (82% vs 98%, P <0.05) and lower 5-year OS (82 % vs 95%, P <0.05). Conclusion: Younger patients were more likely to have non-clear cell RCC with higher disease recurrence and lower OS. They should not be assumed to have similar features and outcomes as screen-detected early RCC in older patients

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

Abstract Introduction: This study examines the prevalence of overweight and obesity in 6-to 72-month-old Chinese preschoolers in Singapore using 3 references. Materials and Methods: This was a population-based cross-sectional study of 3009 Chinese preschoolers aged 6 to 72 months from southwestern and western parts of Singapore. Overweight and obesity were defi ned by using the Center for Disease Control (CDC) (85th and 95th percentile, respectively), the International Obesity Task Force (IOTF) and the local National Health Group Polyclinics (NHGP), Singapore (90th and 97th percentile, respectively) references. Results: The prevalence of overweight and obesity in 24 to 72 months old Chinese children were 8.1% and 7.1% (the CDC reference), 7.6% and 3.9% (the IOTF reference) and 7.5% and 5.3% (the local reference [NHGP]) respectively. For preschoolers aged 6 to 72 months, the prevalence of overweight and obesity was 7.0% and 5.3%, respectively, using the local reference. An increasing trend in the prevalence of obesity with increasing age was seen in both genders, using the CDC and IOTF references (P ≤0.001 and 0.001, respectively). The boys were more likely to be obese than the girls using the CDC reference (OR = 1.42, 95% CI, 1.02 to 1.97, P = 0.03). Conclusion: Our study showed a lower prevalence of overweight and obesity among Chinese preschoolers in Singapore when compared to other countries like the United States, Italy, Chile using the CDC and/or IOTF references. The CDC reference overestimated whereas the IOTF reference underestimated the prevalence of overweight and obesity for our population when compared to using the local NHGP reference

Strategic Design Development for Malawian Public Health Center Labor & Delivery Suites

Introduction: Maternity ward pre-, peri-, and postnatal room sharing creates concerns regarding maternal privacy (particularly confidentiality and dignity), paternal involvement in birthing process, and staff workflow efficiency. This study aimed to understand the current state of the aforementioned concerns and their impact on maternal child bonding and maternal mental health at Queen Elizabeth Central Hospital (QECH). Methods: At discharge, mothers of birth (MOBs) were surveyed on pre-, peri-, and postnatal experience with regard to privacy and paternal involvement in the birthing process, and then assessed using the Mother to Infant Bonding Scale and Edinburg Depression Scale. Father of births (FOBs) or male partners present at discharge were surveyed on quality of experience, level and duration of involvement in the birthing process, and reason for choosing such involvement. All surveys were administered until saturation was reached and then analyzed with inductive thematic analysis. Paths of clinicians and nurse/midwives were mapped using GPS-enabled pedometers for two dayshifts and two nightshifts each. Results: Common themes identified among MOBs (N = 35) included… Major themes identified among FOBs (N = 35) included… An average of ___ and ___ steps per day were taken by clinicians (N = 4) and nurse/midwives (N = 4), respectively, with most time spent … and inefficiencies identified in… Conclusion: Improvements to privacy in the QECH maternity ward are necessary to preserve MOB dignity and confidentiality and promote inclusion of FOBs and male partners in the birthing process. Architectural solutions are necessary to reduce existing inefficiencies in average staff workflow

Prevalence of Metabolic Syndrome Among Patients with Schizophrenia in Singapore

Abstract Introduction: Schizophrenia has been associated with an increased risk of cardiometabolic morbidity and mortality. Metabolic syndrome (MetS), a reliable predictor of cardiovascular-related morbidity and mortality, has also been shown to be more prevalent in patients with schizophrenia. In this study, we investigated the prevalence of MetS in a sample of patients with schizophrenia in Singapore, and the potential risk factors associated with it. Materials & Methods: One hundred patients with schizophrenia and 300 community controls were recruited. All subjects provided a fasted sample of venous blood to measure high-density lipoprotein cholesterol (HDL-C), triglycerides and glucose levels. Weight, height and waist circumference were measured. Presence of MetS was assessed according to the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) guidelines. Results: The prevalence of MetS in patients with schizophrenia was 46.0%. The adjusted odds ratio (OR) for MetS among patients was 2.79 (CI, 1.50 to 5.20, P = 0.001) when compared with controls. Increasing body mass index (BMI) was identifi ed to be signifi cantly associated with the prevalence of MetS. Conclusion: This study found a high prevalence of MetS in Singapore patients with schizophrenia, and that BMI might be a risk factor in the development of MetS. This information is clinically relevant as BMI is routinely measured in psychiatric practice today, and could be used to monitor for development of MetS in schizophrenia

Suicidal Ideation, Suicidal Plan and Suicidal Attempts Among Those with Major Depressive Disorder

Abstract Introduction: The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore. Materials and Methods: The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module. Results: The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were signifi cantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%). Conclusion: Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profi le. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions

Original Research Improvement of Dietary Quality with the Aid of a Low Glycemic Index Diet in Asian Patients with Type 2 Diabetes Mellitus

Objectives: This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM). Methods: Asian patients with T2DM (N 5 104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record. Results: At week 12, both groups achieved the recommendations for carbohydrate (52 6 4% and 54 6 4% of energy) and fat (30 6 4% and 28 6 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A 1c level at week 12 for patients in the lowest GI/GL quartile (D 5 20.7 6 0.1%) compared with those in the highest GI/GL quartile (D 5 20.1 6 0.2%). Conclusions: These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM

Correspondence:

We questioned 180 patients with end-stage renal disease on maintenance haemodialysis, chronic ambulatory peritoneal dialysis and those who had undergone renal transplantation at the Department of Nephrology, General Hospital, Kuala Lumpur. Twelve patients (6.7%) had consumed excessive quantities ofanalgesics prior to the institution oflong-term dialysis or transplantation. Primary renal disease was considered to be analgesic nephropathy in seven patients (3.9%); in five patients (2.8%), analgesic abuse could have been a contributory factor to end-stage renal failure. Analgesic nephropathy is hence an uncommon cause of end-stage renal disease in Malaysia. However, it is important to be aware of the problem and to institute preventive measures as the cost of treatment for end-stage renal disease is prohibitive