Doctors’ knowledge and attitudes on pain assessment and management in Queen Elizabeth Hospital, Kota Kinabalu, Sabah

Introduction: Doctors play an important role to assess and manage pain. Failing to do so properly, pain will affect the quality of life and increase the length of hospital stay for patients. In Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah, pain assessment and management programs have been conducted on a regular basis. However, there has been no studies to assess the effectiveness of these programs. Methodology: This is a cross-sectional study to assess the knowledge and attitude on pain assessment and management among medical officers at QEH. A universal sampling technique was used, to represent medical officers from major clinical departments. The Knowledge and Attitudes Survey Regarding Pain (KASRP) questionnaire was used for this study. Results: A total of 278 questionnaires were distributed to medical officers. The study sample consisted of 125 females (44.9%), and 153 males (55.1%). The age group of the participants ranged from 25 to 41 years old. A 116 respondents scored less than 60% on the knowledge of pain (41.7%). These findings show there was a deficit in their knowledge and attitude about pain. There was also a difference of scores between genders, where the male doctors performed better than the female doctors. There was a difference between scores among doctors from different departments. The highest mean score was from the department of Anaesthesia (80.2%). There was also a difference regarding pain knowledge based on the years of working as a doctor, where the highest passing rate was from doctors working for more than five years. Conclusion: This study demonstrated that there is a lack of knowledge and attitude on pain assessment and management among QEH medical officers who responded to this study. This will support the plan on a more aggressive and continuous education programme to improve pain assessment and management among doctors in QEH

CA-MRSA and Leptospirosis Co-Infections : The recipe to a Successful Management

Co-infection of leptospirosis and Community Acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA) in a healthy pregnant patient is extremely rare. We report a successful medical treatment of a young pregnant patient who presented to our institution with leptospirosis and CA-MRSA

Jehovah’s witness patient undergoing major surgery: Methods to minimize blood loss

Jehovah's Witnesses are a group of people who refuses to get blood transfusions and blood products due to their faith. Due to this, Jehovah's Witness patients who are planned for major surgical procedures are always a challenge for both surgeons and anaesthetist. Surgical and anaesthetic techniques must be aimed at minimising blood loss. We are reporting a peri-operative management for a Jehovah's Witness patient scheduled for a major surgery. This article emphasizes the techniques to minimize blood lose, in order to avoid blood transfusion

A Robust Technique for Edge Detection Using Integration of Entropy Threshold—Canny (InTEC)

Edge detection is one of the important stages in digital image processing and computer vision. In general, edge detection is a process of identifying and validating sudden discontinuities in pixel intensities for grayscale images. This paper focuses on discussing a robust technique in edge detection using integration of several well-known techniques. At first, contrast enhancement approach using contrast limited adaptive histogram equalization (CLAHE) technique was performed to increase the brightness of the images. An adaptive filtering process will be applied in order to reduce noisy elements. To achieve our aims on producing a robust technique, we synthesized Canny technique with modified entropy based method. Based on the conducted performance test, InTEC technique able to identify the edge easily even though the noise percentage increases up to 30%. The high recorded peak signal-to-noise ratio (PSNR) values showed that InTEC technique significantly robust as compared to other prominent techniques

Denture Induced Submandibular Hematoma in a Patient on Warfarin

A 79-year-old lady, who was taking warfarin, presented to the Emergency Department with a painless anterior neck swelling, which was associated with hoarseness of voice, odynophagia, and shortness of breath. She first noticed the swelling after she removed her dentures in the evening. On examination, she had an increased respiratory rate. There was a large submandibular swelling at the anterior side of her neck. Upon mouth opening, there was a hematoma at the base of her tongue, which extended to both sides of the tonsillar pillars. The patient was intubated with a video laryngoscope due to her worsening respiratory distress. Intravenous vitamin K and fresh frozen plasma were given immediately. the patient was admitted to the ICU for ventilation and observation. the hematoma subsided after 2 days and she was discharged well

An audit of Dysphagia patients attending speech therapy clinic at a tertiary hospital in Malaysia

Swallowing involves 55 muscles, five cranial nerves and two cervical nerve roots. When the coordination of this reflex is disturbed, dysphagia occurs. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow or to the sensation that the foods or the liquids are being obstructed in their passage from the mouth to the stomach. The objective of the study was to identify the diagnosis of patients attending Speech Therapy clinic, in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, and to identify the demography of dysphagic patients. From the 406 patients that came during the study period, 139 patients (34.2%) were diagnosed with dysphagia, followed by developmental language disorders (33.3%). Of the 139 patients diagnosed with dysphagia, most of them are within the 41 to 60 (43.2%) and above 60 (42.2%) age groups. The majority were males (66.2%). A total of 81 (58.3%) patients with dysphagia had a history of cerebrovascular accident. Dysphagia is a common disorder among patients attending Speech Therapy Clinics at Queen Elizabeth Hospital, Kota Kinabalu. Training of Speech Therapists and early dysphagia intervention leads to a better outcome

Comparing the ease of intubation between C-MAC, McGrath, and Conventional Macintosh Laryngoscope in a simulated difficult airway of a Laerdal Mannequin

Tracheal intubation is an essential skill for doctors. Tracheal intubation is done in patients with questionable airway patency, poor respiratory drive, hypercarbia, or hypoxia. The objective of this study was to compare the ease of tracheal intubation using Macintosh Laryngoscopes, C-MAC, and McGrath on a simulated difficult airway mannequin. The rationale of the study was to identify the easiest device to use for tracheal intubation. This randomized clinical trial was done at the Teluk Intan Hospital, Perak, Malaysia, from March 2020 to February 2021. Sixty-five medical officers participated in this study. The results showed that the mean time for tracheal intubation was significantly shorter when the participants were using the C-MAC than the conventional direct laryngoscope and McGrath. (C-MAC: 20.8 seconds, Direct Laryngoscope: 27.7 seconds, McGrath: 34.6 seconds) The results showed that C-MAC and McGrath had a better first-attempt success rate than conventional direct laryngoscopes. C-MAC scored the highest first-attempt success rate, followed by McGrath. (95% compared to 83%) Regarding Cormack-Lehane grading, the C-MAC device showed a better view than McGrath and Direct Laryngoscope. The preferred device by medical officers for tracheal intubation was the C-MAC. (45% compared to other devices) In conclusion, the C-MAC device was superior in first attempt success rate and was the most preferred device compared to McGrath and direct laryngoscope. However, using the C-MAC device must be accompanied by adequate training and practice

Process evaluation of student health promotion programmes in rural Sabah

The Faculty of Medicine & health sciences, UMS has implemented a co-curricular programme which is aimed to be improving rural health and reducing inequalities of health in Sabah. Groups of medical students are formed and distributed in various areas of rural remote areas in Sabah. Based on the observation and interview findings, each student group conducted health promotion activities with the limited resources. Various health problems were explored in different areas and different ethnic groups of Sabah and students conducted their health promotion activities .There are some questions “Are they effective, how it works in implementation?” Poor implementation can lead to errors in outcome of the programmes. In this paper we focus on process evaluation for measuring the degree to which Health promotion programmes were implemented as designed by using determinant framework (active implementation framework) and process evaluation tools in yearly health promotion programmes from 2009-2018. Methods: The study measures the implementation of programmes with active implementation framework (Exploration, Installation, Initial implementation, Full implementation) and process evaluation tools such as validation of implementation integrity using specification of intervention areas, making guidelines and manual for intervention protocol, competency of students and supervisors and fidelity monitoring. We used 7 components of process evaluation particularly in context( Environmental influences), reach (Target participation), dose delivered (Lectures), dose received (learned by students with assessment methods), fidelity (Adherence to intervention delivery protocol), implementation (rating of execution and receipt of intervention) and recruitment (participant engagement). Results: It was found that fidelity, implementation strategies and some lessons learned after outreach programmes are importantly influence in implementing the programmes. Conclusion: The study shows process evaluation strategies is ideal tool for conducting the rural outreach health promotion programme to reduce the errors and obstacles in implementing the programmes to maintain the better quality of the projects

Pain management of pemphigus vulgaris

Pemphigus is a rare autoimmune bullous disease which affects the mucous membranes and skin. Pemphigus vulgaris (PV) is the most prevalent type of pemphigus. PV presents with extremely painful, non- healing oral erosions. However, there are only a handful of reports addressing the pain management of PV. We would like to present a case of a painful PV, which was successfully managed

Pre-operative parental anxiety in paediatric surgeries: An Asian experience

Paediatric surgery is a traumatic experience, often accompanied by anxiety in parents. There have been many studies regarding pre-operative anxiety among children, however, there are limited studies exploring the anxiety levels of parents accompanying their child for surgery. This study aims to identify the presence of depression, anxiety, and stress among parents of children undergoing elective surgery in a tertiary hospital in Malaysia. The study population consisted of children who were scheduled for elective minor surgery between January 2018 to June 2018. The 21-item depression anxiety stress scale (DASS-21) questionnaire was used. The majority of accompanying parents had a normal depression, anxiety, and stress scores. However, there was severe to extremely severe depression, anxiety, and stress in some parents. The results showed that accompanying parents with higher level of fear tend to develop more anxiety and stress. There were no significant changes in their scores in relation to gender, history of previous surgery or history of anaesthesia clinic visit. Anxiety among accompanying parents in children undergoing surgery is an underestimated problem. It needs to be identified and managed effectively to provide better care to the child undergoing surgery and anaesthesia