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Chronic wounds are associated with significant clinical, economic and quality‐of‐life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5‐week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter‐rater and intra‐rater reliability between clinical and TA‐based measurements were analysed using intra‐class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5‐week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter‐rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799‐0.919, P < 0.001). Separate measurements of intra‐rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967‐0.985 and range 0.977‐0.984 respectively, P < 0.001). Inter‐rater reliability between TA used on the iOS and Android systems was also excellent (0.987‐0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity. [ABSTRACT FROM AUTHOR]

Background: Shared decision‐making has been shown to improve the quality of life in metastatic breast cancer patients in high‐literacy and high‐resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision‐making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision‐making is at the forefront. This paper aims to identify (1) barriers to practising shared decision‐making faced by healthcare professionals and patients and (2) strategies for implementing shared decision‐making in the context of metastatic breast cancer management in Malaysia. Methods: We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi‐structured in‐depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. Results: Five main themes emerged from the study: healthcare provider–patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision‐making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. Conclusion: This study found that practising shared decision‐making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision‐making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider–patient barriers identified in this study. Patient or Public Contribution: Patients were involved in the study design, recruitment and analysis. [ABSTRACT FROM AUTHOR]

Intelligent tutoring and personalization are considered as the two most important factors in the research of learning systems and environments. An effective tool that can be used to improve problem-solving ability is an Intelligent Tutoring System which is capable of mimicking a human tutor's actions in implementing a one-to-one personalized and adaptive teaching. In this paper, a novel Flowchart-based Intelligent Tutoring System ( FITS) is proposed benefiting from Bayesian networks for the process of decision making so as to aid students in problem-solving activities and learning computer programming. FITS not only takes full advantage of Bayesian networks, but also benefits from a multi-agent system using an automatic text-to-flowchart conversion approach for engaging novice programmers in flowchart development with the aim of improving their problem-solving skills. In the end, in order to investigate the efficacy of FITS in problem-solving ability acquisition, a quasi-experimental design was adopted by this research. According to the results, students in the FITS group experienced better improvement in their problem-solving abilities than those in the control group. Moreover, with regard to the improvement of a user's problem-solving ability, FITS has shown to be considerably effective for students with different levels of prior knowledge, especially for those with a lower level of prior knowledge. [ABSTRACT FROM AUTHOR]

Determining the true reasons for happiness that exist in different social groups is important, especially in the case of those groups where poverty strongly dominates people's well‐being and happiness. To understand the factors that determine happiness among poor communities, this study collected data in the form of 1,793 responses from low‐income communities, who constitute 40% of Malaysia's workforce. To ascertain the feelings and emotional responses of the target group, primary source data were collected based on a questionnaire survey utilising the Lokman Emotion Importance Quadrant (LEIQ™) model. The data were analysed using text mining techniques based on R‐Language software. According to the findings, happiness in Malaysian low‐income communities is primarily shaped by concerns about family matters such as success, care issues, education and so on. Interestingly, government financial support, money, income and work matters are only fifth in importance, and lastly, the least emphasis was put on the public transportation issue. To ensure the true happiness and wellbeing of people who are struggling financially, policymakers must provide not only financial assistance but also ensure a better future for their families: better healthcare, better incomes, keeping a roof over their heads, etc. This study will be useful to the government, development agencies, NGOs, international organisations and other stakeholders wanting to realise the United Nations' Sustainable Development Goals (SDGs) in Malaysia and similarly affected countries. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Background: Physical assessment skills are essential to clinical decision‐making in nursing as they help nurses to identify and respond to patients' deterioration. Nurses develop confidence and can detect any out‐of‐range parameters in diagnosing and treating patients. Prior studies surveyed 120 skills but did not explicitly assess critical care. Aim: To determine the range of physical assessment skills practised by critical care nurses and their adoption factors. Study design: This study uses a cross‐sectional survey design. A self‐administered questionnaire evaluating 40 physical assessment skills was conducted with 133 staff nurses (response rate: 96.4%) in three critical care units at a Malaysian government hospital between November 2019 and January 2020. Results: Most nurses applied 32 (80%) skills during every working shift, involving the vital signs and all body systems except the gastrointestinal system. Five skills (12.5%) were occasionally applied, while three skills (7.5%) were rarely applied or not part of most nurses' clinical practice. About 20% of the nurses did not routinely check the respiration rate. Medical and surgical intensive care unit nurses (U = 1129, p <.001) and nurses who had served over 10 years (H (2) = 9.60, p =.008) used more physical assessment skills than others. Nurses felt that continuing nursing education, participating in relevant courses and implementing standardised forms to record physical assessments would improve the application of such skills. Conclusion: Clinical practice in these critical care settings challenges the assertion that physical assessment is vital to critical care nursing roles. Concerns highlighted by the nurses should be addressed by nursing management so that the application of physical assessment skills can be enhanced, especially in critical care settings. Relevance to Clinical Practice: The findings indicated that physical assessment skills in critical care need to be improved. Education and training should emphasise these skills. [ABSTRACT FROM AUTHOR]

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Background: COVID‐19 is a threat to everyone's health and can be especially devastating to older individuals. Aim: This study examined the behavioural prevention practices against SARS‐CoV‐2 infection and the intention to vaccinate among older people when the COVID‐19 vaccine is on the verge of becoming available. Method: A cross‐sectional, online survey was conducted between 14th July and 8th October 2020 among the older people in Malaysia. A questionnaire was designed to assess the practice towards measures preventing SARS‐CoV‐2 infection, and COVID‐19 vaccination attitudes and intention. Socio‐demographic characteristics, constructs of a health belief model (HBM), the 6‐item state version of the State‐Trait Anxiety Inventory (STAI‐6) were correlates of the main outcomes. Findings: The mean score of total preventive measures scores was 13.4 ± 1.7 out of a maximum score of 15, indicating very good prevention practices. By demographics, females, having a tertiary education exhibited higher prevention practices in the univariable analyses. Components of the HBM and being female remain significant correlates of higher prevention practices in multivariable logistic regression analysis (MLRA). A total of 657 (87.1%) participants responded and intend to receive the COVID‐19 vaccination. Provider recommendations may improve vaccination uptake (91.6%). MLRA revealed that having a positive vaccination attitude was 16 times more likely to accept the COVID‐19 vaccination (OR = 16.10; 95% CI 8.97–28.91). Hearing of someone they know who has COVID‐19 serves as a cue to action and significantly influences vaccination (OR = 4.25; 95% CI 1.80–10.03). Participants below 70 years old expressed higher vaccination intention (OR = 2.07; 95% CI 1.19–3.58). Conclusion: The results provide the first evidence for public authorities to target older people vulnerable to compliance with recommended preventive measures against SARS‐CoV‐2 infections. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the psychometric properties of the Bahasa Malaysia (BM) version of the Older Americans Resources and Services‐Instrumental Activities of Daily Living (OARS‐IADL) questionnaire among older persons in Malaysia. Methods: The English version of OARS‐IADL was translated to BM. The psychometric properties of the BM version of OARS‐IADL were tested among older persons attending a health‐care facility. Results: Two hundred and seventy‐one older persons participated in the study. The mean age of participants was 67.7 ± 6.1 years. Internal consistency of the items was good (Cronbach's alpha, >0.7). Exploratory factor analysis revealed a single dimension with item factor loadings of >0.5. Confirmatory factor analysis results confirmed a single‐factor model (AVE > 50%, CR > 0.7 and CR > AVE). Conclusion: The BM version of the OARS‐IADL questionnaire is a valid and reliable instrument that can be used to assess the IADL among older persons in Malaysia. [ABSTRACT FROM AUTHOR]

Background: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia. Aims and objectives: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables. Design This was a cross‐sectional survey. Methods: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ2 and hierarchical logistic regression tests were used to analyse the data. Results: A total of 229 CCNs completed the self‐administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave. Conclusion: This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases. Relevance to clinical practice: Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses. [ABSTRACT FROM AUTHOR]

Background: Nurses play a key role in the proper management of endotracheal tube (ETT) cuff pressure, which is important for patients' safety, so it is vital to improve nurses' knowledge on safe cuff management practices. Aims and objectives: This study aimed to evaluate the effectiveness of an educational intervention related to ETT cuff pressure management on improving and retaining critical care nurses' knowledge. Design: A single group pre‐post interventional study was conducted involving 112 registered nurses (RNs) from a 24‐bed adult general intensive care unit at a teaching hospital in Malaysia. Methods: The educational intervention included a theoretical session on endotracheal cuff pressure management and demonstration plus hands‐on practice with the conventional cuff pressure monitoring method. Nurses' knowledge was measured using a self‐administered questionnaire pre‐ and post‐intervention. Data were analysed using repeated measure analysis of variance and bivariate analysis. Results: In this study, 92% of the total number of RNs in the unit participated. A significant difference in mean knowledge score was noted between the pre‐ (mean = 8.13; SD = 1.53) and post‐intervention phases (3 months [mean = 8.97; SD = 1.57) and 9 months post‐intervention [mean = 10.34; SD = 1.08), P <.001), indicating significant knowledge acquisition and retention between the phases. Knowledge gained between the pre‐ and 9 months post‐intervention phases significantly differed according to nurses' educational level. Conclusions: This study supports existing evidence that ongoing educational interventions are essential to improve nurses' knowledge. However, further exploration is suggested to assess how well this knowledge is translated into clinical practice. Relevance to clinical practice: Regular educational programmes with current updates would enhance nurses' knowledge through proper practice and clinical decision‐making skills; this, in turn, would help to standardize cuff management practices. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to determine the prevalence and risk factors of alcohol use among a cohort of population in Sabah. Design: This is a prospective, cohort study involving rural community residents. Setting: Rural community resident at Bingkor, Keningau, Sabah. Participants: 363 individuals aged 13 years old and above. Intervention: Community‐based participatory research to determine the prevalence and risk factors associated with alcohol use. Main outcome measures: Measurement of alcohol use using Alcohol Use Disorders Identification Test (AUDIT) and assessment of psychiatric morbidity using Mini International Neuropsychiatric Interview (MINI) questionnaires. Results: Most alcohol drinkers aged between 36‐45 years old, followed by 26‐35 years old and 46‐55 years old. Interestingly, there are almost similar female to male ratio. Most were Kadazan‐Dusun ethnic, non‐Muslims, and married. Although only less than a third of the participants received tertiary education, the majority were working. Based on the findings, being a male, non‐Muslim and having an obsessive‐compulsive disorder (OCD) (current) posed a significantly higher risk of alcohol consumption. Conclusion: A worryingly high prevalence of hazardous alcohol consumption among the locals is reported. There is a need for population‐wide intervention towards preventive measures based on the identified risk factors for hazardous alcohol use. [ABSTRACT FROM AUTHOR]

Drug‐related issues, such as inappropriate drug dosing, are pervasive patient issues that are particularly common among chronic kidney disease (CKD) patients. Pharmacists have the expertise to play an important role in avoiding such problems. The aim of the present study was to explore pharmacists' self‐perceived knowledge, attitude and practice towards dosage adjustment among CKD patients. A cross‐sectional, Web‐based, self‐administered survey was conducted among 1594 registered pharmacists in Malaysia. Participants were surveyed regarding their perceived knowledge, attitude and implementation of drug dosage adjustment based on renal function among CKD patients in their practice. The study was completed by 234 pharmacists (14.7%). More than four‐fifths of respondents (n = 199) reported that they are practicing dosage adjustment. The median self‐perceived knowledge score was 27.0 (of a total of 45). Pharmacists younger than 29 years of age and those practicing in hospitals had higher knowledge of drug dosage adjustments. Female pharmacists were more likely to express interest in being involved in the identification, monitoring and resolution of drug therapy problems for CKD patients (p = 0.02). The two most common obstacles reported by pharmacists who did not practice dosage adjustment were a lack of information regarding a patient's renal function status (76%) and medical history (74%). Further training should be given to pharmacists to improve knowledge and awareness. An alert card could be implemented to record a patient's renal function to improve communication between hospitals and primary care settings. [ABSTRACT FROM AUTHOR]

The assessment of information literacy (IL) at the school level is mainly dependent on the measurement tools developed by the Western world. These tools need to be efficiently adapted and in most cases translated to allow them to be utilized in other cultures, languages, and countries. To date, there have been no standard guidelines to adapt these tools; hence, the results may be cross‐culturally generalized to a certain extent. Furthermore, most data analyses produce generic outcomes without taking into account the ability of the students, including the difficulty of the test items. The present study proposes a systematic approach for context adaptation and language translation of the preexisting IL assessment tool known as TRAILS‐9 to be used in different languages and context, particularly a Malaysian public secondary school. This study further administers a less common psychometric approach, the Rasch analysis, to validate the adapted instrument. This technique produces a hierarchy of item difficulty within the assessment domain that enables the ability level of the students to be differentiated based on item difficulty. The recommended scale adaptation guidelines are able to reduce the misinterpretation of scores from instruments in multiple languages as well as contribute to parallel development of IL assessment among secondary school students from different populations. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Coronary heart disease has emerged as a number one killer in Malaysia and globally. Much of the morbidity and mortality in acute coronary syndrome patients is because of patients not recognizing their symptoms which contributes to delay in seeking early treatment. Aim: The aim of this study is to evaluate the effectiveness of a nurse‐led health education programme on knowledge, attitude and beliefs of coronary patients towards the responses to acute coronary syndrome and the association with patients' characteristics. Methods: A single‐group quasi‐experimental design took place in a tertiary hospital. A total of 60 coronary patients were recruited to this study. The knowledge, attitude and beliefs towards acute coronary syndrome (ACS) were evaluated at baseline and after 1 month of giving education intervention. Results: Knowledge, attitude and beliefs about ACS increased significantly from baseline to 1 month after intervention. Level of attitude was associated with gender, educational level and employment status. Conclusions: The findings of this study suggest that an education program conducted by a nurse improved patients' level of knowledge, attitudes and beliefs in response to ACS symptoms at 1 month compared to baseline, but whether they are sustained for a longer period is unclear. Improving the responses towards ACS might reduce decision delay in symptom interpretation and seeking early treatment. Relevance to clinical practice: Nurse‐led interventions have imparted positive outcomes in response to ACS symptoms among coronary patients. Therefore, nurses should take the initiative in educating patients to minimize delay in symptom interpretation and seeking early treatment. [ABSTRACT FROM AUTHOR]

Background: The link between psychosocial stress and cognitive function is complex, and previous studies have indicated that it may be mediated by processing speed. Therefore, the main aim of this study was to examine whether processing speed mediates the association between psychosocial stress and global cognition in older adults. Moreover, the moderating role of gender in this model is examined as well. Methods: The study included 2322 community‐dwelling older adults in Malaysia who were randomly selected through a multistage proportional cluster random sampling technique. Global cognition construct was measured by the Mini‐Mental State Examination and Montreal Cognitive Assessment; psychosocial stress construct was measured by perceived stress, depression, loneliness, and neuroticism; and processing speed was assessed by the Digit Symbol Substitution Test. Structural equation modelling was used to analyze the mediation and moderation tests. Results: Processing speed was found to partially mediate the relationship between psychosocial stress and global cognition (β in the direct model = −0.15, P < 0.001; β in the full mediation model = −0.11, P < 0.001). Moreover, the relationship between psychosocial stress and global cognition was found to be significant in men only, whereas the association between processing speed and global cognition was significant in men and women. Conclusions: Psychosocial stress may increase the likelihood that older adults will experience poor processing capacity, which could reduce their higher level cognition. Results indicate that there is a need to develop processing capacity intervention programmes for psychologically distressed older adults to prevent them from suffering cognitive decline. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients. Aims and objectives This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes. Design A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention. Methods A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention. Results Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low ( M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions ( M = 3·68, SD = 1·13) and nurses' workload ( M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities. Conclusions Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills. Relevance to clinical practice Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses. [ABSTRACT FROM AUTHOR]

Objective To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China. Methods Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank. Results Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12). Conclusions Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study aimed to determine attitudes and practices of intensive care unit ( ICU) nurses towards provision of oral care for intubated patients. Background Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens. Design This was a cross-sectional study. Methods Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire. Results Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%). Conclusions The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital. Relevance to clinical practice Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care. [ABSTRACT FROM AUTHOR]

The Catastrophic Cognitions Questionnaire‐Modified (CCQ‐M) is a common instrument for measuring catastrophic thoughts. In some countries, however, CCQ‐M still poses concerns following the lack of appropriate validation among their populations. The current study aimed to examine the factor structure of the CCQ‐M, the reliability, and the validity in community samples in Malaysia. The Malay version of CCQ‐M and additional measures assessing the symptoms and cognitions relevant to anxiety disorders were completed by 682 university students and general community. Exploratory factor analysis revealed a two‐factor structure accounting for 62.2% of the total variance. Confirmatory factor analysis confirmed the two‐factor model by deleting four items. The Cronbach's alpha coefficients for the total and the two subscales were.94,.90, and.92, respectively. Test–retest reliability analysis was conducted on 82 university students in the interval period of 14 days, and the result was r = .58. Evidence supported the concurrent, convergent, and discriminant validity. In conclusion, the 17‐item CCQ‐M‐Malaysia is a valid and reliable instrument for assessing catastrophic cognitions among Malaysian populations. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Sedation management is an integral component of critical care practice. It requires the greatest attention of critical care practitioners because it carries significant risks to patients. Therefore, it is imperative that nurses are aware of potential adverse consequences of sedation therapy and current sedation practice recommendations. Aims and objectives To evaluate the impact of an educational intervention on nurses' knowledge of sedation assessment and management. Designs and methods A quasi-experimental design with a pre- and post-test method was used. The educational intervention included theoretical sessions on assessing and managing sedation and hands-on sedation assessment practice using the Richmond Agitation Sedation Scale. Its effect was measured using self-administered questionnaire, completed at the baseline level and 3 months following the intervention. Results Participants were 68 registered nurses from an intensive care unit of a teaching hospital in Malaysia. Significant increases in overall mean knowledge scores were observed from pre- to post-intervention phases (mean of 79·00 versus 102·00, p < 0·001). Nurses with fewer than 5 years of work experience, less than 26 years old, and with a only basic nursing education had significantly greater level of knowledge improvement at the post-intervention phase compared to other colleagues, with mean differences of 24·64 ( p = 0·001), 23·81 ( p = 0·027) and 27·25 ( p = 0·0001), respectively. A repeated-measures analysis of variance revealed a statistically significant effect of educational intervention on knowledge score after controlling for age, years of work and level of nursing education ( p = 0·0001, ηp2 = 0·431). Conclusion An educational intervention consisting of theoretical sessions and hands-on sedation assessment practice was found effective in improving nurses' knowledge and understanding of sedation management. Relevance to clinical practice This study highlighted the importance of continuing education to increase nurses' understanding of intensive care practices, which is vital for improving the quality of patient care. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate parental perception of neighbourhood environments and safety in association with children's physical activity among primary school children in Klang, Selangor, Malaysia. Methods A total of 250 children (9-12 years of age) and their parents participated in this cross-sectional study. Physical Activity Questionnaire for Older Children and Neighbourhood Environmental Walkability Scale as well as questions on constrained behaviours (avoidance and defensive behaviours) were used to assess the children's physical activity and parental perception of neighbourhood environment and safety, respectively. Results More than one-third (36.0%) of the children were physically inactive compared with only a small percentage (4.8%) who were physically active, with boys achieving higher physical activity levels than girls ( t = 2.564, P = 0.011). For the environmental scale, parents' perception of land-use mix (access) ( r = 0.173, P = 0.006), traffic hazards ( r = −0.152, P = 0.016) and defensive behaviour ( r = −0.024, P = 0.143) correlated significantly with children's physical activity. In multiple linear regression analysis, child's gender ( β = −0.226; P = 0.003), parent's education ( β = 0.140; P = 0.001), household income ( β = 0.151; P = 0.024), land-use mix (access) ( β = 0.134; P = 0.011) and defensive behaviour ( β = −0.017; P = 0.038) were significantly associated with physical activity in children ( R = 0.349, F = 6.760; P < 0.001), contributing 12.2% of the variances in physical activity of the children. Conclusion Results highlight the links between parental perception of neighbourhood environments, safety and constrained behaviours with their children's participation in active play. Interventions aimed to increase actual and perceived safety and reduce perceptions of risk by parents in safe neighbourhoods can be targeted to increase children's physical activity in their local neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health‐care professionals' (HCPs) expectation of a PDA is unknown. Aim: We aimed to explore patients' and health‐care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM). Design: We used a qualitative design and thematic approach. Setting: Three main primary health‐care settings in Malaysia: public university‐based primary care clinics, public health‐care clinics and private general practices. Method: We conducted focus groups and one‐to‐one interviews with a purposive sample of health professionals and patients with type 2 diabetes. Results: We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side‐effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand. Conclusion: It is important to consider including issues related to psycho‐social impact of treatment to patients when developing a patient decision aid. [ABSTRACT FROM AUTHOR]

Background Physical functioning and psychological resilience in adulthood is shaped during adolescence. Self-reported health-related quality of life (HRQoL) assessments during this life phase are important first-hand accounts of their well-being. This study aimed, firstly, to identify differences in HRQoL according to gender, ethnicity, socio-economic status and weight status; and secondly, to examine associations between weight status and HRQoL among an urban sample of multi-ethnic adolescents in Kuala Lumpur, Malaysia. Methods A cross-sectional study involving 652 adolescents (aged 13 years) was conducted in Kuala Lumpur. Weight and height were measured. Body mass index z-scores were categorized according to the International Obesity Task Force criteria. HRQoL was assessed using the Malay version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Univariate analyses of differences in HRQoL according to gender, ethnicity (Malays, Chinese and Indians), maternal education level and weight status were performed. Complex samples general linear model was used to examine the associations between HRQoL and weight status, adjusted for confounders. Results Female adolescents reported significantly lower emotional functioning scores (mean, 95% confidence interval: 59.25, 57.33-61.17).When the three main ethnic groups were studied, Malay adolescents scored significantly lower emotional functioning scores (59.00, 57.13-60.87) compared with their Chinese peers. Adolescents with tertiary-educated mothers reported lower emotional functioning scores (57.45, 53.85-61.06) compared with those with primary-educated mothers. Obese adolescents reported poorer HRQoL scores with significantly impaired physical and social functioning after controlling for confounders. Conclusions These findings detected disparities in HRQoL among the adolescents when gender, ethnicity, maternal education level and weight status were considered. Further studies should address these health inequalities by implementing gender-specific and culturally appropriate measures to attain optimal well-being and avoid potential burden of disease. [ABSTRACT FROM AUTHOR]