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

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

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Communication Versus Geography : The Case Study of Sarawak Homestay Operator Association

Homestay is being developed throughout the decades making it as one of the best tourism product in Malaysia. The increasing number of homestay in Sarawak each year is challenging the communication among each other administratively. Communication among all the homestay is vital in order for the information could be reached in a timely manner. Without a proper communication media used to communicate, a lot of important information could be missed out causing some of the homestays to be left out. This research is conducted to study the communication used among the homestay operators using both quantitative and qualitative methods. Interviews are conducted with the representatives of Sarawak Homestay Operator Association (SHOA) and questionnaires are distributed to the homestay operators in gathering the information. Locations could not be changed as locations are the unique selling point of a homestay and recommendations can be addressed to have mobile communication towers within the vicinity of the homestays to improve the signals. It is revealed that communication issues could be resolved if operators are actively involved as there are a variety of apps available in the market for these operators to choose fro

CPR: Bright side of machine-human relationship

Cardio pulmonary resuscitation (CPR) is a common procedure at Accident and Emergency Department, especially in the Red Zone or Resuscitation Room. This procedure is done as a method to save patients’ life, especially in the event of cardiac arrest. Medical doctors or nurses do continuous cycles of chest compressions manually in order to ensure the heart keep pumping. This is vital in making sure blood supply to the heart and brain is not interrupted. The external force needed to compress the chest is a result of continuous pressing of the heart at the level of mid chest. One cannot deny, the process can be exhausting and can cause muscular pain to the medical doctors or nurses. However, with innovation and technology, nowadays, CPR can be done using machine. The objective of this study is to justify how the relationship of human and machine, has not only save patients life, but also able to safe the medical doctors and nurses from the risk of musculoskeletal disorder (MSD). This study has been carried out at Red Zone of Accident and Emergency Department, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia. During this study, 10 medical doctors participated. 8 females and 2 male doctors were voluntarily involved in this study. All of them were asked to perform CPR while standing on the floor and while standing on a stool and patient lying on the bed. Their body postures were recorded and score were given based on Rapid Entire Body Assessment (REBA). This score will determine whether they might have the risk of MSD due to performing CPR or not. For this study, a mannequin was used instead of real patient. Two mechanical CPR device machines were selected in this study, which were LUCAS and AutoPULSE. CPR by these machines was also performed on the mannequin. Result showed, REBA scores are high risk and very high risk. The REBA score when performing CPR while standing on stool were higher compared to REBA score when performing CPR while standing on the floor. Thus, the existing machine-like LUCAS and AutoPULSE in doing CPR not only save patients life, but also have helped the medical doctors and nurses as well. The teaming between machine and human in this study has proven to bring benefits to human life, especially to the medical doctors and nurses

Gelatin-Based Film as a Color Indicator in Food-Spoilage Observation: A Review

The color indicator can monitor the quality and safety of food products due to its sensitive nature toward various pH levels. A color indicator helps consumers monitor the freshness of food products since it is difficult for them to depend solely on their appearance. Thus, this review could provide alternative suggestions to solve the food-spoilage determination, especially for perishable food. Usually, food spoilage happens due to protein and lipid oxidation, enzymatic reaction, and microbial activity that will cause an alteration of the pH level. Due to their broad-spectrum properties, natural sources such as anthocyanin, curcumin, and betacyanin are commonly used in developing color indicators. They can also improve the gelatin-based film’s morphology and significant drawbacks. Incorporating natural colorants into the gelatin-based film can improve the film’s strength, gas-barrier properties, and water-vapor permeability and provide antioxidant and antimicrobial properties. Hence, the color indicator can be utilized as an effective tool to monitor and control the shelf life of packaged foods. Nevertheless, future studies should consider the determination of food-spoilage observation using natural colorants from betacyanin, chlorophyll, and carotenoids, as well as the determination of gas levels in food spoilage, especially carbon dioxide gas

Ultrasound roles in aiding emergency department renal tubular acidosis diagnosis

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Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

Abstract Background We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism. Case presentation A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission. Conclusions Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome