Stridor in children: croup or something more sinister? A case of subglottic cyst

Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may lead to respiratory compromise with a potentially serious and fatal outcome. The diversity of the clinical presentations throws a great challenge in the diagnosis of subglottic cysts. Manifestations vary as they depend on the size and location of the cysts. We report the case of a 6-month-old girl who had a subglottic cyst but managed as moderate croup till she developed worsening respiratory acidosis which difficult intubation. Any case of premature infants with previous history of neonatal intubation presenting with stridor should prompt clinicians to look for possible cysts in the larynx. This is important because once the diagnosis is made, appropriate treatment may be given and unnecessary morbidity and mortality may be avoided

Simulation in healthcare in the realm of Education 4.0

The advent of Education 4.0, in parallel with Industrial Revolution (IR) 4.0, has translated into an evolution in healthcare education. Simultaneously, as a result of concerns in doctors’ competency and patient safety, simulation shot into center-stage in the field of healthcare education. Generally, there are five modalities in healthcare education, namely role-play (verbal), standardized patient, part-task trainer, computer or screen-based simulation, and electronic patients including virtual reality. Dissecting the nine principles of Education 4.0, this article reviews the relevance and role of the five different modalities of simulation in easing healthcare education into the mold of Education 4.0

Challenges in embracing virtual reality from healthcare professional’s perspective: a qualitative study

Virtual reality (VR) in healthcare is relatively new concept and the views of healthcare professionals (HCPs) on its potential should be studied. We set out to investigate the perception of HCPs concerning VR’s feasibility and utility in healthcare. An exploratory qualitative study was conducted among HCPs in a medical teaching institution in the Klang Valley, Malaysia from March until July 2021. Focus group discussions were held using semi-structured questions consisting of four categories i.e., utility, training, development and resources and obstacles were developed deductively prior to the study. They were analysed using thematic coding. The data were presented in the form of categories, themes and quotes. Seven doctors, four allied health professionals and four science officers were among the fifteen respondents. A total of 16 themes were derived out of the four categories which were usage, purpose, new modality, individual experience, patient safety, trainer trainer safety, training standardisation, logistic, interactivity, cost to consumers, potentiality, management support, limitation, funding, lack of expertise, and mindset ignorance. Apart from safety concerns, high VR technology costs were expected to become more affordable in the future. Cybersickness was also of a concern. This study demonstrated that VR was feasible in healthcare education and practice if several critical factors were considered, including increased funding, a more favourable mindset, increased visibility, awareness of available resources and increased collaboration between technical and subject matter experts. As VR acts as simulation, VR ensures trainee's, teacher's and patient's safety while allowing more flexible training in a variety of clinical scenarios

Current developments of microwave filters for wideband applications

This paper presents a compilation of important review in the development of microwave filters for wideband technology used in previous years. The major research work for each year is reviewed. Several wideband filters based on the planar and non-planar circuits are compared and examined in order to propose a new topology of wideband filter using Suspended Stripline Structure (SSS). More importantly, this new proposed structure will be integrated with the Defects Ground Structure (DGS) to form an advanced hybrid system for wideband applications. This system will produce the band-pass and band-stop responses simultaneously in order to discriminate between the desired and undesired signals in the wideband spectrum. The proposed system outlined in this paper, featuring new innovation in hybrid structure as well as providing an insight of the direction of future research works. The contribution of this study is useful for applications where the reduction of physical volume is very important, while maintaining its good performance such as Ultra-Wideband (UWB), commercial radar as well as the wideband warfare receiver. As for future works, integration techniques between the UWB filter and DGS will be designed and analyzed to form an advanced new microwave device in order to produce bandpass and bandreject response in the same structure simultaneously

Peer trainers compared with basic life support trainers in delivering effective cardiopulmonary resuscitation training to secondary school students

Teaching cardiopulmonary resuscitation (CPR) skills to the public is essential in improving cardiac arrest survival. American Heart Association suggested to incorporate it into the school curriculum. Peer trainers is a low cost and effective method in achieving this. The objective of this 3 months prospective controlled study was to compare the effectiveness of teaching compression only CPR between peers and certified basic life support (BLS) trainers to secondary school students. Improvement in knowledge and psychomotor skills of CPR compression were the primary outcome evaluated. Twelve peer trainers aged 16-years-old and twelve certified BLS trainers were recruited into the study. Compression only CPR was taught to 36 randomized secondary school students by either peer trainers (Group P) or BLS trainers (Group B). A pre-test, immediate post-test and 3 months retention test on knowledge and psychomotor skill were conducted. There was no statistically a significant difference in the mean scores of knowledge and psychomotor at pre-test, post-test and 3 months retention between Group P and Group B. There was significant increase of knowledge score between pre-test and post-test in Group P (mean difference 5.8+2.7, p<0.001) and in Group B (mean difference 4.7+2.7, p<0.001). Psychomotor score was significantly increased between pre-test and post -test in Group P (mean difference 7.11+1.49, p<0.001) and Group B (mean difference 7.22+1.5, p<0.001). Peer trainers is non-inferior to BLS trainers in teaching CPR to secondary school students as both groups showed significant improvement at post-test

School indoor air pollutants: In relation to allergy and respiratory symptoms among school children in urban areas

Indoor air pollutants affect children’s health and previous research mostly focuses on respiratory and allergic diseases. However, little is known about the risks among school children in East Malaysia. Therefore, we studied associations between school children’s respiratory and allergic symptoms and indoor air pollutants in schools in Sabah, Malaysia. We randomly selected 332 school children (14 years old) from 24 classrooms in 6 secondary schools in Kota Kinabalu, Sabah. Information on personal characteristics, respiratory and allergic symptoms were gathered by using a standard questionnaire. The skin prick test was used to characterize their atopy. In each classroom, the indoor concentrations of particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2 ), formaldehyde, total volatile organic compounds (TVOC), carbon dioxide (CO2 ) temperature and relative humidity were monitored. Overall, 11.7% reported doctor-diagnosed asthma, 14.8% wheezing, 17.5% day-time breathlessness, 37.0% breathlessness after exercise, 13.0% breathlessness at night-time, 55.1% rhinitis and 10.8% skin allergic in the last 12 months. Regression analysis showed that the onset of wheezing was common in doctor diagnosed asthma (OR= 8.29, 95% CI= 3.70-16.10) and with parental asthma/allergy (OR= 2.13, 95% CI= 1.10-4.15), and associated with concentrations of NO2 (OR= 1.03, 95% CI= 1.01-1.21) and CO2 (OR= 1.01, 95% CI= 1.01-1.11). Day-time breathlessness was associated with indoor NO2 (OR=1.02, 95% CI= 1.02-1.35) and TVOC (OR= 1.30, 95% CI= 1.10-1.52). The indoor concentrations of NO2 , CO2 , TVOC and PM2.5 as well as parental asthma/allergy, and parental smoking were risk factors to the health outcome of respiratory and allergic symptoms

A qualitative study on emergency health care worker (EHCW) prception towards COVID-ACLS simulation training in resuscitating suspected COVID-19 patients

The emergence of COVID-19 pandemic has caused difficulty to emergency-HCW (EHCW) in resuscitating high-risk patients. We set out to explore EHCW’s perception after undergoing COVID-ACLS resuscitation training and address their anxiety of working in this pandemic. A qualitative case study using focused group discussion was conducted among EHCW who have undergone COVID-ACLS training. Five semi-structured questions exploring respondent’s confidence level, anxiety factors, areas of improvement for COVID-ACLS and if this COVID-ACLS training is sufficient. Inductive and deductive thematic analysis approach was done to analyse the result. 20 EHCW participated in this study. Out of 4 themes, 11 subthemes were identified based on the respondents. They were acquired new knowledge, self-precaution, method of delivery, concerns of self and family members, stigmatisation, insufficient protective methods, underappreciation, regular training sessions, other modalities for learning, course duration; and unsatisfactory reading material. New knowledge and self-precaution were noted to be an important aspect that boosts confidence among EHCW. The main factor that increased anxiety was safety issues and disease spreading to family members, colleagues, and society. In conclusion, COVID-ACLS training is able to boost EHCW confidence in resuscitating high-risk patients. Factors leading to anxiety among EHCW should also be addressed during this pandemic to ensure psychological welfare and mental health are not affected. Regular training and utilisation of other teaching modalities such as video are perceived as a helpful adjunct in boosting their confidence. The utilisation of new training approach should be explored in enhancing EHCW’s knowledge and confidence

Do no harm, stay current: immersive trauma continuous medical education for emergency medicine postgraduate trainees

Continuous medical education (CME) is an essential component of postgraduate education to improve trainees’ competencies level to be at par with the current clinical practice thereby improving overall quality of patient healthcare delivery. As a postgraduate trainee in addition to being a part of hospital workforce, providing a compact CME session is essential albeit the learning challenges. Therefore, a framework for the trauma CME program was developed to integrate trainee-led immersive active learning (AL) activities based on our emergency medicine postgraduate training curriculum. It comprised of three components which were miniconferences on trauma management principles updates; hands-on skill stations session utilizing pre-prepared learning packages, simulated scenarios, manikins and phantoms; and immersive trauma simulation on prehospital response, radio communication and patient resuscitation combined with formative assessments and debriefing session. Google Form platform was used to gather the trainees’ self-appraisals of the learning experience. Feedbacks from the trainees revealed that the sessions were engaging and appropriate to their level of training. In conclusion, by incorporating AL activities into immersive trauma CME, it promotes trainees’ engagement towards teaching and learning activities thus consolidating their knowledge and skills on handling trauma patients

Evaluation of the relationship between fractional exhaled nitric oxide (FeNO) with indoor PM10, PM2.5 and NO2 in suburban and urban schools

Numerous epidemiological studies have evaluated the association of fractional exhaled nitric oxide (FeNO) and indoor air pollutants, but limited information available of the risks between schools located in suburban and urban areas. We therefore investigated the association of FeNO levels with indoor particulate matter (PM10 and PM2.5), and nitrogen dioxide (NO2) exposure in suburban and urban school areas. A comparative cross-sectional study was undertaken among secondary school students in eight schools located in the suburban and urban areas in the district of Hulu Langat, Selangor, Malaysia. A total of 470 school children (aged 14 years old) were randomly selected, their FeNO levels were measured, and allergic skin prick tests were conducted. The PM2.5, PM10, NO2, and carbon dioxide (CO2), temperature, and relative humidity were measured inside the classrooms. We found that the median of FeNO in the school children from urban areas (22.0 ppb, IQR = 32.0) were slightly higher as compared to the suburban group (19.5 ppb, IQR = 24.0). After adjustment of potential confounders, the two-level hierarchical multiple logistic regression models showed that the concentrations of PM2.5 were significantly associated with elevated of FeNO (>20 ppb) in school children from suburban (OR = 1.42, 95% CI = 1.17–1.72) and urban (OR = 1.30, 95% CI = 1.10–1.91) areas. Despite the concentrations of NO2 being below the local and international recommendation guidelines, NO2 was found to be significantly associated with the elevated FeNO levels among school children from suburban areas (OR = 1.11, 95% CI = 1.06–1.17). The findings of this study support the evidence of indoor pollutants in the school micro-environment associated with FeNO levels among school children from suburban and urban areas