Effectiveness of debriefing towards healthcare professionals’ nontechnical skills: a critical review

The importance of nontechnical skills among healthcare professionals is gaining widespread recognition as critical elements complementing technical skills that are used to improve patients’ safety. These skills are typically acquired through simulation training which has emerged as an effective way to complement clinical training. Effective simulation requires structure and effective debriefing methods to enhance its learning outcome. In previous literature, evidence of the effectiveness of healthcare simulation was available but studies evaluating debriefing method(s) remain sparse. In this paper, the effectiveness of debriefing methods in eight studies on the acquisition of nontechnical skills among healthcare professionals is reviewed. Articles published from 1st January 2016 across three different databases were referred to. The results of the review show a statistically significant improvement in the performance of nontechnical and technical skills across different professionals through various methods of debriefing. Nontechnical skills such as teamwork, effective communication, decision-making, and situational awareness have improved significantly. In addition, integration of realism in simulation learning has begun to emerge as an effective technique of providing a real world experience. However, there was lack of detailed information on the length and type of debriefing conducted in the studies. These methods clearly require further research since the key to successful simulation learning is through debriefing which is the heart of simulation

Intervensi kesihatan di tempat kerja bagi aktiviti fizikal dan atau nutrisi di negara-negara berpendapatan rendah dan sederhana: satu ulasan sistematik

Sebuah ulasan sistematik telah dibuat dengan tujuan untuk merumuskan program intervensi kesihatan di tempat kerja bagi aktiviti fizikal dan atau nutrisi bagi negara-negara berpendapatan rendah dan sederhana bermula Januari 2008 hingga Disember 2019. Objektif kajian ini adalah untuk mengenalpasti jenis-jenis intervensi kesihatan dan mengkaji kesan intervensi kesihatan bagi peningkatan aktiviti fizikal dan atau nutrisi di tempat kerja bagi negara berpendapatan rendah dan sederhana. Pencarian secara sistematik dilakukan dengan menggunakan pengkalan data Scopus, PubMed dan Web of Science. Kajian ini telah dilaporkan dalam Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). Penilaian kritikal menggunakan kaedah McMaster yang telah diubahsuai bagi kajian kuantitatif untuk mendapatkan kualiti metodologi kajian. Oleh sebab keheterogenan data ini, sintesis secara deskriptif dilakukan. Daripada 6940 data kajian yang didapati, 36 kajian menepati semua kriteria inklusi yang merangkumi pendidikan kesihatan, perubahan persekitaran dan perubahan tingkah laku melalui amalan gaya hidup sihat. Rumusan hasil dapatan menunjukkan bahawa intervensi kesihatan di tempat kerja boleh memberi kesan positif terhadap kesihatan dan tingkah laku pekerja. Walaupun hasil dapatan menunjukkan kesan yang positif, namun dapatan kajian adalah kurang seragam dan kurang jelas dari segi parameter intervensi dan pengukuran hasil, maka ini telah mengehadkan perkembangan aplikasi hasil ini. Kesimpulannya, intervensi kesihatan di tempat kerja menunjukkan potensi untuk meningkatkan aktiviti fizikal dan menambahbaik nutrisi di kalangan pekerja. Walaupun saranan tentang keberkesanan intervensi tidak dapat dibuat, namun diharap, hasil dapatan ulasan sistematik ini dapat menjadi panduan bagi tujuan amalan dan polisi bagi promosi kesihatan di tempat kerja, pada masa akan datang

Amalan berkesan bagi ulasan terhadap simulasi kemahiran bukan teknikal dalam kalangan profesional penjagaan kesihatan: satu kajian sistematik

Kepentingan kemahiran bukan teknikal bagi golongan profesional dalam bidang penjagaan kesihatan telah berkembang dengan pesat dan mula mendapat pengiktirafan sebagai salah satu elemen kritikal yang melengkapi kemahiran teknikal dalam meningkatkan keselamatan pesakit. Kemahiran ini diperolehi menerusi latihan simulasi yang kini berkembang sebagai kaedah yang efektif dan saling melengkapi bagi latihan berbentuk klinikal. Kemahiran bukan teknikal seringkali menggunakan simulasi dengan fideliti yang tinggi dan diikuti dengan perbincangan berbantu yang dikenali sebagai ulasan. Ulasan oleh fasilitator terlatih dianggap penting bagi memastikan pembelajaran berkesan dapat dicapai menerusi proses refleksi. Namun begitu, masih terdapat kelompangan dari sudut elemen yang menyumbang terhadap keberkesanan sesuatu sesi ulasan. Artikel ini mengulas tentang elemen di dalam ulasan yang telah dimanipulasikan serta keberkesanannya terhadap penguasaan kemahiran bukan teknikal bagi golongan profesional dalam bidang penjagaan kesihatan menerusi lapan buah artikel dengan menggunakan empat pengkalan data berbeza. Prestasi kemahiran bukan teknikal meningkat apabila sesi ulasan dimanipulasikan seperti penggunaan multimedia, ulasan kendiri atau tanpa sesi ulasan. Malah, tiada peningkatan tambahan terhadap prestasi kemahiran bukan teknikal apabila penggunaan video digunakan di dalam ulasan berbantu fasilitator. Aplikasi teori pembelajaran terhadap elemen tertentu berserta dengan aplikasi model ulasan spesifik amat ditekankan bagi memastikan sesi ulasan dapat dilaksanakan dengan berkesan

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study [version 1; referees: 2 approved, 1 approved with reservations]

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children

Faktor-faktor yang mempengaruhi kemapanan intervensi obesiti juara sihat daripada perspektif kanak-kanak: satu kajian kualitatif

Prevalens berlebihan berat badan dan obesiti kanak-kanak secara global telah meningkat secara mendadak dalam beberapa tahun ini, termasuk di Malaysia. Intervensi obesiti yang dijalankan di sekolah penting untuk menggalakkan gaya hidup sihat dan perubahan tingkah laku. Terdapat banyak intervensi yang telah dijalankan bagi menangani masalah obesiti kanak-kanak; namun, kemapanan intervensi obesiti kanak-kanak sering kali diabaikan. Tujuan kajian ini adalah untuk meneroka persepsi kanak-kanak tentang faktor-faktor yang mempengaruhi kemapanan intervensi Juara Sihat di sekolah rendah di Kuala Lumpur. Temu bual bersemuka mendalam dijalankan dengan 26 responden berumur 12 hingga 14 tahun yang dipilih melalui persampelan bertujuan daripada kanak-kanak yang terlibat di dalam program Juara Sihat tersebut. Transkripsi data verbatim dilakukan dan analisis tema dijalankan. Kajian ini mendapati tema utama yang dikenalpasti sebagai faktor penggalak adalah (1) sokongan keluarga, fasilitator, guru sekolah, dan kawan-kawan; (2) amalan aktiviti fizikal dan pemakanan sihat selepas intervensi; (3) kesedaran kendiri; (4) pengetahuan terhadap piramid makanan dan pemakanan sihat; dan (5) persekitaran rumah, manakala faktor penghalang adalah (1) tidak konsisten dalam pengetahuan; (2) keselamatan diri; (3) rakan sebaya; (4) sikap peribadi; dan (5) bosan terhadap program. Hasil kajian menunjukkan faktor penggalak kemapanan intervensi Juara Sihat yang utama adalah amalan aktiviti fizikal dan pemakanan sihat, manakala faktor penghalang utama adalah tidak konsisten dalam pengetahuan. Oleh itu, intervensi obesiti kanak-kanak berasaskan sekolah perlu mempertimbangkan faktor-faktor ini yang mempengaruhi kemapanan intervensi. Kajian masa depan dicadangkan untuk mempertimbangkan faktor-faktor tersebut ketika perancangan program intervensi obesiti kanak-kanak untuk meningkatkan keberkesanan intervensi obesiti untuk jangka masa yang lebih panjang

Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers

Introduction: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers. Methods: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers. Results: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among ex- smokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030). Conclusion: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups

Perception of harms and benefits of electronic cigarettes among adult Malaysian men: a comparison by electronic cigarette use and smoking status

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.312.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies

Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial

Aims To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care. Design Two-arm cluster-randomized controlled effectiveness trial across 19 sites with followup at 4-week, 3-month, and 6-month. Setting Stop smoking services operating in public hospitals in Malaysia. Participants Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition. Intervention and comparator The intervention consisted of training stop-smoking practitioners to deliver support and follow-up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow-up). Measurements The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired-air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO-verified tobacco smoking abstinence up to 4 weeks and 3 months. Results Follow-up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6-month follow-up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention-to-treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow-up-only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22–20.77, P = 0.025) and 1.70, (95% CI = 0.25–11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow-ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis. Conclusions On an intention-to-treat analysis with missing-equals-smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow-up rates

Characterizing employees with primary and secondary caregiving responsibilities: informal care provision in Malaysia

There is a need to determine the extent to which Malaysian employees reconcile both paid employment and informal care provision. We examined data from the Malaysia’s Healthiest Workplace via AIA Vitality Online Survey 2019 (N = 17,286). A multivariate multinomial regression was conducted to examine characteristics for the following groups: primary caregiver of a child or disabled child, primary caregiver of a disabled adult or elderly individual, primary caregiver for both children and elderly, as well as secondary caregivers. Respondent mean age ± SD was 34.76 ± 9.31, with 49.6% (n = 8573), identifying as either a primary or secondary caregiver to at least one child under 18 years, an elderly individual, or both. Males (n = 6957; 40.2%) had higher odds of being primary caregivers to children (OR 2.06; 95% CI 1.85–2.30), elderly (OR 1.24; 95% CI 1.09–1.41) and both children and elderly (OR 1.87; 95% CI 1.57–2.22). However, males were less likely to be secondary caregivers than females (OR 0.61; 95% CI 0.53–0.71). Our results highlight the differences in characteristics of employees engaged in informal care provision, and to a lesser degree, the extent to which mid-life individual employees are sandwiched into caring for children and/or the elderly

Prevalence and factors associated with attempts to quit and smoking cessation in Malaysia

Smoking cessation significantly reduces risk of smoking-related diseases and mortality. This study aims to determine the prevalence and factors associated with attempts to quit and smoking cessation among adult current smokers in Malaysia. Data from the National E-Cigarette Survey 2016 were analyzed. Forty nine percent of current smokers had attempted to quit at least once in the past 12 months and 31.4% of the respondents were former smokers. Multivariable analysis revealed that current smokers with low nicotine addiction and aged below 45 years were more likely to attempt to quit smoking. Being married, older age group, and having tertiary education were significantly associated with smoking cessation. Only half of the current smokers ever attempted to quit smoking and only a third of smokers quit. Stronger tobacco control policies are needed in Malaysia to encourage more smokers to quit smoking. Improved access to cessation support for underprivileged smokers is also needed