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Background Magnetic resonance imaging (MRI) safety screening is a crucial procedure for patient preparation before entering into MRI room. Many hospitals in Malaysia are still using the MRI safety checklist printed form. Besides, clinicians will not get a definite conclusion about whether the patient is contraindicated for MRI or not. Hence, we have created one mobile application named MagnetoSafe to overcome this issue. The application will provide an instant decision on whether the patient has no contraindication, relative contraindication, or absolute contraindicated for MRI. We need to check for acceptability and user experience for any newly created mobile application. Objective This study was designed to check the validity of the adapted Technology Acceptance Model (TAM) and System Usability Scale (SUS) Questionnaire. Method The validity and reliability of the questionnaire were investigated. Subsequently, 52 fully completed responses were collected. Results Face and content validity of the questionnaires are considered acceptable with only minor changes to Item 10 of SUS. The Cronbach's alpha for the SUS questionnaire (10 questions) is −0.49, which is not acceptable. The Cronbach's alpha for TAM questionnaire (3 domains; 14 questions) is acceptable, which is 0.910 for perceived usefulness, 0.843 for perceived ease of use, and 0.915 for intention to use. Conclusion Face validity of the adapted SUS and modified TAM questionnaires is acceptable with only minor changes to Item 10 in SUS. Content validity with experts is good. However, the reliability of the SUS questionnaire is not acceptable and therefore adapted SUS will not be used for assessing user experience. The reliability of the modified TAM questionnaire with the original three-factor structure is considered acceptable and can be used to evaluate the user's acceptability of MagnetoSafe.

Complementary and alternative therapies (CATs) are tremendously popular as an adjunct treatment for treating various health conditions but limited literature is available on the extent of use and perception among adolescents. This study aimed to 1) assess the general utilization and perception toward CATs and 2) compare the perception between CATs users and non-CATs users among secondary school students in Kuala Terengganu. A cross-sectional study was conducted among 99 students of a secondary school in Terengganu, Malaysia using convenience sampling. Responses were analysed via descriptive analysis and non-parametric tests using SPSS (v21). Among the participants (age = 15.3 ± 0.6 years; female = 78.8%), 23.2% had previously used some types of CATs, with herbal or dietary supplements (56.5%) being the most common. Participants’ utilization towards CATs were mostly influenced by their family and friends (82.6%). The students gained information about CATs from the internet (67.7%), followed by physicians (62.6%) and family/friends (61.6%). Most students have favourable opinions regarding CATs usage with no significant association between CATs users and non-users (p > 0.05). Nonetheless, CATs users scored higher in their beliefs that CATs has fewer side effects in comparison to conventional medicine (p = 0.050). From the findings, this study has provided some early evidence on the positive perceptions harboured by adolescents in Terengganu regarding CATs. Further approaches should be taken to educate the students about the fundamentals of CATs use to ensure their safety and efficacy.

During the initial phase of the coronavirus disease 2019 (COVID-19) pandemic, there was a critical need to create a valid and reliable screening and surveillance for university staff and students. Consequently, 11 medical experts participated in this cross-sectional study to judge three risk categories of either low, medium, or high, for all 1536 possible combinations of 11 key COVID-19 predictors. The independent experts’ judgement on each combination was recorded via a novel dashboard-based rating method which presented combinations of these predictors in a dynamic display within Microsoft Excel. The validated instrument also incorporated an innovative algorithm-derived deduction for efficient rating tasks. The results of the study revealed an ordinal-weighted agreement coefficient of 0.81 (0.79 to 0.82, p-value < 0.001) that reached a substantial class of inferential benchmarking. Meanwhile, on average, the novel algorithm eliminated 76.0% of rating tasks by deducing risk categories based on experts’ ratings for prior combinations. As a result, this study reported a valid, complete, practical, and efficient method for COVID-19 health screening via a reliable combinatorial-based experts’ judgement. The new method to risk assessment may also prove applicable for wider fields of practice whenever a high-stakes decision-making relies on experts’ agreement on combinations of important criteria.

In higher education setting throughout the world, the practise of handwashing among staff is essential, particularly in the period of COVID-19 pandemic. Despite the overwhelming evidence on the effectiveness of proper handwashing, the knowledge, attitude and practice of handwashing among the staff of higher education have not been well investigated. Consequently, a cross-sectional study among staff in a university in Malaysia was conducted to identify the prevalence of proper handwashing and its associated factors. The data was collected using questionnaires in Google form from 18th June to 21st June 2020. Statistical analyses involved simple and multiple logistic regression with backward likelihood ratio method. Out of 349 participants, 31.8% (95% CI: 26.9,36.7) had proper handwashing practice. The results of the multivariable analysis revealed that the total knowledge scores (OR: 1.04, 95% CI: 1.001, 1.071) and the total attitude scores (OR: 1.23, 95% CI: 1.152, 1.321) were found to be significantly associated with proper handwashing practice among staff. Our study suggests that having the right knowledge and favourable attitudes are crucial towards achieving the proper handwashing practise. Additional supports for promoting a conducive ecosystem may also likely be needed to sustain a long-term practice of proper handwashing.

Awareness of the dietary fibre intake (DF) and its importance in prevention and management of type 2 diabetes mellitus (T2DM) among rural people is seldom reported in Malaysia. This study aimed to determine the knowledge, attitude, and practice (KAP) of DF intake and their association with type 2 diabetes mellitus (T2DM) among rural people in Terengganu, Malaysia. A community-based cross-sectional study was carried out among the households in Kampung Jati, Kuala Nerus, Terengganu, Malaysia from 29th December 2019 until 20th February 2020. The village has 524 houses, the data was collected from all available and eligible subjects in each household by completed socio-demographic, validated KAP on DF intake questionnaire, as well as a 24-hour dietary recall using a self-administered questionnaire. In our study of 396 respondents, 208 (52.5%) were men. The mean age of participants was 37.85 (15.13). Most of the subjects were Malay 384 (97.0%), employed 207 (52.3%) and 274 (69.2%) attained high level of education (from tertiary school level). However, only 170 (42.9%) had a high family income which was of >RM 3860 per month. Out of 396 respondents, 157 (39.6%) of them had family history of diabetes mellitus. Respondents had moderate knowledge (39.1%), positive attitude (88.1%) and good practice (59.3%) scores towards DF intake. Among the respondents, only 39.1% of total respondents knew the nationally recommended amount of daily fibre intake which is of 20-30 grams per day. With multivariable analysis using multiple logistic regression, the analysis results revealed that age (adjusted OR: 1.11, 95% CI: 1.08, 1.15; p

Purpose: Radiology teaching via the traditional lecture (TL) is susceptible to a decline in focus and engagement, leading to compromised training and competency. In this study, we investigated the teaching of radiology topics via informal cooperative learning (ICL). Materials and Methods: We randomly delivered teaching via the TL or the ICL to four clinical group of thirteen third-year undergraduate medical students. The study involved eleven radiology topics throughout one academic year. For each topic, two groups underwent the TL while the other two learned via the ICL. All students underwent a pre-test at the beginning of each class, consist of One Best Answer (OBA) and Objectively Structured Clinical Examination (OSCE) to assess knowledge and skills, respectively. They subsequently underwent post-tests with another OBA and OSCE assessments at the end of class and six weeks later. Results: Students who learned from the ICL classes scored significantly higher in the knowledge assessment immediately post-teaching, six weeks later, and the overall score regardless of time. Assessments of skills showed no statistically significant difference between the two teaching methods. However, for both the ICL and TL, post-teaching scores of knowledge and post-teaching scores of skills were significantly higher than the pre-test. Conclusion: Our study provides empirical evidence on the superior competency of undergraduate radiological skills through the ICL. The findings signify the need to engineer competent doctors via innovative clinical training. The novel experience from this study better-orientate radiology teaching and contribute to the broader field of medical education, clinical practice, and patient safety.

The number of cases of cyber bullying reported in schools had been alarming in these recent years. Increased accessibility of mobile phone and internet among secondary school students have made them more susceptible of becoming cyber bullying victims. These victims consequently will encounter mental health problems such as depression and anger that may lead to psychosomatic disorder and suicidal attempt in severe cases. This study focussed on determining the prevalence of cyber bullying and its associated factors among secondary school students. A cross sectional study was conducted among 482 of Form 2 and Form 4 school students in Kuala Terengganu. Data were collected using self-administered questionnaires. Data were analysed by using SPSS version 22. The descriptive statistics was applied to obtain frequency and percentage for categorical data. Simple logistic regression and Pearson Chi-square were used to determine the association between the independent variables and cyber bullying victimisation. The prevalence of cyber bullying victims in this study was 2.1% and total of 8.1% reported had been cyber bullied for lifetime. Four factors were found to be significantly associated with being a victim of cyber bullying; age (p = 0.010), type of school (p = 0.036), gender (p = 0.011) and perception towards family relationship (p = 0.006). In conclusion, the prevalence of cyber bullying victimisation in Kuala Terengganu is low in comparison to worldwide data. Although the prevalence is low, cyber-victimisation is progressing in numbers by year and there is a need to plan for proper intervention programs to enhance awareness among secondary school students to curb this issue.

Worldwide, 40% of children, 33% and 35% of male and female non-smokers respectively, were regularly exposed to second-hand smoke indoors. The practice to avoid second hand smoke at home are mostly individual-driven although in public places SHS can be executed by laws and policies such as gazetted smoke-free zones. A cross sectional study was conducted at Flat Bukit Kecil, Kuala Terengganu involving 211 respondents. Self-administered questionnaire was used and data were analysed. Descriptive statistics and Pearson chi square were employed. Findings revealed significant associations between socio demographic factors; gender (p=0.002), ethnicity (p=0.006), and occupational status (p=0.014) with SHS exposure. SHS exposure was also found to be significantly associated with respondents’ vaping (p=0.035) and smoking status (p

Obesity and overweight problems are serious global health issues today and despite many efforts, the prevalence has continued to rise for decades. Interestingly, hypnotherapy has been gaining recognition as an effective treatment for obesity and overweight problems. This review compiles contemporary scientific research on the effectiveness of hypnotherapy for weight reduction. Scopus, PubMed and EBSCO Host databases were applied in the study. The search identified 119 articles, of which seven met the inclusion criteria. A total of 539 respondents (82.7% women and 17.3% men) between the ages of 17 and 67 years were represented in the seven studies. Most studies incorporated lifestyle changes, such as changes of dietary habit and behavioral recommendations in the hypnotic procedure. Their results suggested that the use of hypnotherapy not only promoted weight reduction during the treatment period but also after treatment cessation, and in some cases, one to ten kilograms were lost during follow-up periods. In addition, one study even showed increased physical activity among the hypnotised individuals. This use of hypnotherapy also improved respondents’ eating behavior and quality of life. However, a definitive conclusion could not be drawn due to several methodological flaws and the limited number of published studies in this area. Therefore, further well-designed studies are needed to substantiate the effectiveness of hypnotherapy for this modern-day health problem.

Background Medication use process in the emergency department (ED) can be challenging and the risk for medication error (ME) to occur is high. In Malaysia, several studies on ME have been conducted in various hospital settings. However, little is known about the prevalence of ME in emergency department (ED) in these hospitals. The objective of this study was to determine the prevalence and characteristics of ME at an ED of a teaching hospital in Malaysia. Methods A cross-sectional study was conducted over the period of 9 weeks in patients who visited the ED of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Data on patient medication orders and demographic information was collected from the doctor’s clerking sheet. Observations were made on nursing activities and these were documented in the data collection form. Other information related to the administration of medications were obtained from the nursing care records. Results Observations and data collections were made for 547 patients who fulfilled the study criteria. From these, 311 patient data were randomly selected for analysis. Ninety-five patients had at least one ME. The prevalence of ME was calculated to be 30.5%. The most common types of ME were wrong time error (46.9%), unauthorized drug error (25.4%), omission error (18.5%) and dose error (9.2%). The most frequently drug associated with ME was analgesics. No adverse event was observed. Conclusions The prevalence of ME in our ED setting was moderately high. However, the majority of them did not result in any adverse event. Intervention measures are needed to prevent further occurrence.

Hypnosis has been increasingly used in recent years as an alternative treatment to maintain well-being. Yet, limited evidence is available regarding its role in weight management, especially in Malaysia. Hence, this quasi-experimental study was conducted to evaluate the effectiveness of hypnosis on weight loss and body composition (body mass index, waist circumference and body fat percentage) among staff and students of a public university in Terengganu, Malaysia. Participants with body mass index (BMI) ≥ 25.0 kg/m

Despite various strategies, overweight and obesity problems are still increasingly prevalent worldwide with serious health outcomes. Consequently, the continuous demand for more effective, safe and acceptable therapies for reducing body weight is also escalating—including complementary and alternative therapies (CATs). The aim of this review is to provide a summary of the most commonly- and recently-used CATs, with evaluation of their safety and efficacy for weight loss. Electronic scientific databases such as Scopus, PubMed and EBSCO Host were explored for articles that reported CATs for overweight and obesity treatment from 2015 to December 2019. Only systematic reviews, meta-analysis and randomized controlled trials (RCTs) published in English were included. Studies whereby CATs were not utilized for reducing body weight were excluded. Eight systematic reviews and meta-analyses and 11 additional RCTs with 765 participants (50.2% overweight and 49.8% obese) related to hypnotherapy, acupuncture and dietary supplements met the inclusion criteria. Their results suggested that spirulina, chitosan, probiotic, EPA + DHA, vitamin D, fiber, and herbal extract supplementation may all provide small reductions in body weight (ranging from 1-10 kg). Interestingly, hypnotherapy and acupuncture reported significantly greater reduction in body weight compared with placebo (p < 0.001 and p < 0.0001, respectively). Nonetheless, the evidence is still relatively limited and not encouraging to provide a definitive conclusion due to the methodological shortcomings and the presence of adverse events in chitosan and fiber supplementation. Hence, studies of this nature need to be further replicated and improved to corroborate the efficacy and safety of the CATs to combat weight issues.

Through the regional control programme, Malaysia has been successfully reducing the incidence of Plasmodium falciparum and Plasmodium vivax infections. However, the incidence of zoonotic malaria Plasmodium knowlesi infection is increasing and now has been the major cause of malaria in Malaysia especially Malaysian Borneo. The emergence of knowlesi infection has threatened the malaria elimination programme which the government aims to reduce the overall malaria infections by 2020. Unlike other benign human Plasmodium spp., P. knowlesi can cause fatal infections. The aim of this study was to determine the incidence and distribution of five human malaria parasites including P. knowlesi in Peninsular Malaysia and Malaysian Borneo. A total of 112 blood samples were collected from seven states and district hospitals in Peninsular Malaysia and Malaysian Borneo from year 2015 to 2016. The samples were examined by microscopy and further confirmed by nested PCR assay targeting 18S rRNA gene of Plasmodium spp. Following the nested PCR assays, a total of 54 (48.2%) samples were positive for P. knowlesi infections, 12 (10.7%) cases were positive for P. vivax infections, followed by 7 (6.3%) cases of P. falciparum and 4 (3.5%) cases of P. malariae. There were 3 cases (2.7%) of mixed infections (P. knowlesi/P. vivax). However, no cases were identified as P. ovale. A total of 32 (28.6%) cases were found as negative infections. LoopMediated Isothermal Amplification Assay (LAMP) was performed to confirm inconclusive results produced by microscopy and nested PCR. P. knowlesi showed the highest prevalence in Sarawak (n= 30), Sabah (n=13), Pulau Pinang (n=5) and Pahang (n=6). PCR and LAMP was not able to detect a large number of microscopy positive samples due to DNA degradation during storage and shipping. Among all the states involved in this study, the highest prevalence of P. knowlesi infection was found in Sabah and Sarawak.

Background: Medication errors (MEs) continue to pose a significant problem to health care systems across the world, not only causing harm and death in patients but also consuming approximately $42 billion annually in health care expenditure. The emergency department (ED) is considered a high-risk area of having MEs to occur. Little is known about the associated factors of ME in the ED of hospitals in Malaysia. Objective: The objective of this study was to determine the factors associated with ME in an ED of a teaching hospital. Methods: A cross-sectional study was conducted on patients who visited the ED of Hospital Universiti Sains Malaysia over 9 weeks during normal working hours (ie, 8:00 am-5:00 pm). A total of 547 patients who satisfied the inclusion criteria were enrolled for the study. Patient demographic information, clinical characteristics, and medication orders and procedures were observed and recorded. The required number of patient data (n = 311) were selected randomly for analysis. Multiple logistic regression method was employed to determine factors associated with ME. Results: Of the 311 patient data, 95 (30.5%) patients had at least 1 ME. The factors found to be associated with ME were number of medications (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.51-2.41), triage (adjusted OR, 0.11; 95% CI, 0.04-0.27), gender (adjusted OR, 0.50; 95% CI, 0.26-0.93), and time of patient visit (adjusted OR, 0.34; 95% CI, 0.52-0.75). Conclusion: Medication error was not uncommon in our ED setting. Patients with a higher number of medications prescribed during visit to the ED were found to be particularly at risk. Identification of such factors may guide intervention measures to prevent MEs in this setting.

Literature has documented that student nurses undergo stress in their academic and clinical setting. This raises concerns because stress during undergraduate training may result in psychological or emotional impairment during the nurses’ professional life and ultimately affect the quality of patient care. The Objective of the study was to study the prevalence of stress, and the association between sociodemographic factors, stressors and coping strategies with stress. This was a cross-sectional study on 96-year 1-3 nursing students from a government university done between 2015-2018. Bahasa Malaysia translated The General Health Questionnaire, Stressors in Nursing Student Scale Questionnaire and Brief COPE Questionnaire was used in this study. This study had Malay (95.9%) and female (91.7%) dominated population. The prevalence of stress in student nurses was 25%. No association was reported between sociodemographic factors and stress. Among the 4 stressors educational, clinical, confidence and financial, clinical stressor scored the highest mean 6.40 (SD±3.66). Confidence stressor (AOR=1.26 95% CI 1.04-1.53) was the only stressor associated with stress. The top 3 coping strategies practiced by the student nurses were religion (praying), acceptance and planning. Self-blame (AOR 8.18 95% CI 1.86-35.91) was the only coping strategy associated with stress. Stress management programmes, and workshops on stress and coping strategies should be conducted yearly to ensure a well-balanced environment for good learning experiences and prevent stress related health problems and improved academic performance.

Introduction: Obesity and overweight are among the most serious public health issues that can threaten the well-being of individuals. Its increasing prevalence in Malaysia has inevitably caused many to additionally seek complementary and alternative therapies (CATs) to lose weight. This study intends to 1) assess the utilization and perception toward CATs among obese and overweight participants and 2) assess applicability, practicality, reliability and validity of the UPCATs-Malay. Materials and methods: It was conducted cross-sectionally on 30 students and staff. Responses were analyzed using SPSS (v21). Results: Among the participants (age = 26.17±8.23 years; female = 66.7%; students = 63.3%), 40.0% were overweight and 60.0% were obese. Overall, 23.3% of the participants had previously used some types of CATs to lose weight, with herbal or dietary supplements (20.0%) being the most common. Participants’ attitudes towards CATs were mostly influenced by the internet (93.3%). Most believed that CATs modalities were safe (53.3%) and not a threat to public health (70.0%). The majority of participants (53.3%) were also considering joining any CATs-based weight management programmes. Additionally, the questionnaire was considered clear, comprehensive and not difficult to complete (< 5 minutes). The overall reliability was 0.711 (domain range = 0.641-0.881). Majority of individual items in UPCATs-Malay correlated better with their domains compared to other domains supporting validity. Conclusion: Overall, positive perceptions towards CATs were apparent and the questionnaire was reliable and valid. Further approaches should be taken especially on the identification of safe, viable CATs modalities and their role in weight management.

BACKGROUND Despite the current popularity and potential usage of mobile applications in promoting dietary behavior, hypnotherapy for weight loss applications are scarcely available and the credibility of information is of concern. OBJECTIVE The purpose of this review are to 1) provide up-to-date existing hypnotherapy apps focusing on weight reduction and 2) evaluate the features and information provided in the mobile apps. METHODS Google Play and Apple’s iTunes stores were searched for available applications related to the hypnotherapy targeting weight loss from 20 August 2020 to 20 September 2020. Only free, English apps were included. Apps in which the hypnotherapy was not utilized for weight loss or which contain no elements of hypnotherapy were not included. RESULTS Of 291 identified apps, 22 met the requirements for inclusion and were further reviewed. Fourteen of the apps (63.6%) focused on reducing calorie intake and limiting intake of fattening and sugary foods through hypnotic suggestions. Most apps delivered hypnotherapy via audio track (77.3%) and 68% enabled the session to be customized. More than 40% of apps developers claimed to have used a licensed hypnotherapist and 25% of apps contained disclaimers in the descriptions. Additionally, 31.8% of the classified apps earned high ratings from users (between 4 and 5 stars). CONCLUSIONS Overall findings suggest that weight-loss hypnotherapy applications may be useful as an approach to assist conventional weight management strategies. However, several issues regarding the contents and credibility should be highlighted in order to improve the quality and substantiate the effectiveness of weight-loss hypnotherapy apps in future. CLINICALTRIAL MENTOR-MENTEE RESEARCH GRANT (UNISZA/2018/011/R0046-R001)

Objectives The global epidemic of overweight and obesity presents a major challenge in the health status of the society. Their prevalence is at an alarming rate worldwide due to poor compliance with conventional treatment and high rates of relapse, thus increasing demand for an effective and safe alternative approach such as hypnotherapy. This study aimed to evaluate the feasibility and acceptability of hypnotherapy for weight loss and to compare these among selected socio-demographics. Methods A cross-sectional study was conducted among 30 students and staff of a public university in Terengganu, Malaysia using convenience sampling. Data analysis was carried out using SPSS 23.0. Results Among the respondents (age = 26.17 ± 8.23 years; female = 66.7%; students = 63.3%), 40.0% were overweight and 60.0% were obese. Results indicated excellent feasibility as determined by participants’ satisfaction towards the clarity of hypnotherapist’s voice (93.3%), the suitability of content (86.7%) and time spent for the session (90.0%). Good overall acceptability (>60.0%) was also reported regarding hypnotherapist professionalism, the environment and perceived usefulness of hypnotherapy. Obese individuals were significantly more satisfied towards the hypnotherapist environment than overweight respondents (p=0.015). Additionally, no adverse effects were reported after the intervention. Conclusions This evidence signalled that hypnotherapy is a promising alternative tool in assisting overweight and obese individuals to lose weight. Extensive research is needed to substantiate its role in weight management programs for its full benefits.

Objective Traditional and Complementary Medicines (TCM) are widely used worldwide, and many of them have the potential to cause toxicity, interaction with conventional medications and non-adherence to prescribed medications due to patients' preference for the TCM use. However, information regarding their use among patients seeking care at emergency departments (ED) of a healthcare facility is limited. The study aimed to evaluate the TCM use among patients attending the ED of a teaching hospital in Malaysia. Study design A sub-analysis of data from a prevalence study of medication-related visits among patients at the ED of Hospital Universiti Sains Malaysia was conducted. The study took place over a period of six weeks from December 2014 to January 2015 involving 434 eligible patients. Data on demography, conventional medication, and TCM uses were collected from patient interview and the medical folders. Results Among this cohort, 66 patients (15.2%, 95%CI 12.0, 19.0) reported concurrent TCM use. Sixteen (24.2%) of the TCM users were using more than one (1) type of TCM, and 17 (25.8%) came to the ED for medication-related reasons. Traditional Malay Medicine (TMM) was the most frequently used TCM by the patients. Five patients (7.6%) sought treatment at the ED for medical problems related to use of TCM. Conclusion Patients seeking medical care at the ED may be currently using TCM. ED-physicians should be aware of these therapies and should always ask patients about the TCM use.

Objectives This study aimed to assess the oral health and the prevalence of pre-existing oral colonization with respiratory pathogens in dependent elderly, and whether these factors influence pneumonia development. Materials and Methods Participants residing in a long-term care facility received bedside oral examinations, and information on their oral health (caries status, calculus index and debris index) was obtained. Samples from the tongue and teeth were collected at baseline and at time of pneumonia development. Sputum was collected at the time of pneumonia diagnosis. Samples were assessed for Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae by polymerase chain reaction. Results This was a 1-year longitudinal study of 60 dependent elderly (mean age: 64.2 ± 14.1 years). Seventeen patients (28.3%) developed pneumonia. The mean Decayed, Missing and Filled Teeth and Simplified Oral Hygiene Index were 22.8 ± 9.2 and 4.0 ± 1.0, respectively. At baseline, 48.3% were orally colonized with ≥1 respiratory pathogens. The presence of H. influenzae (P = .002) and P. aeruginosa (P = .049) in the sputum was significantly associated with their colonization on the tongue at baseline. In the bivariate analyses, pneumonia development was associated with naso-gastric feeding tube (P = .0001), H. influenzae (P = .015) and P. aeruginosa (P = .003) tongue colonization at baseline and calculus index (P = .002). Multivariate analyses revealed that calculus index (P = .09) and the presence of tracheostomy (P = .037) were associated with pneumonia. Conclusions The calculus amount and tongue colonization with respiratory pathogens are risk factors for pneumonia development. Oral hygiene measures to remove tongue biofilm and calculus may reduce pneumonia development.

Objective: Following hip arthroplasty surgeries, leg length inequality (LLI) has been reported to be a leading cause of orthopaedic surgery malpractice claims. Most of them developed lengthening of the limb rather than shortening. Small lengthening (≤10 mm) are usually well tolerated by patients and may go unnoticed. In fact, absolute equalisation of limbs length is difficult to achieve and LLI could be minimised but not be avoided. Therefore, this cross-sectional study analysed and compared the LLI between two different techniques of hip arthroplasty (HA); Cemented and cementless. Materials and methods: Twenty-six patients underwent HA within the period from January 2012 to December 2014, 5 (19.2%) of them underwent cemented HA while 21 (80.8%) patients underwent cementless HA. The same principal orthopaedic surgeon has performed all these surgeries to reduce the bias that observed in other similar studies which were conducted by multiple surgeons. The method of measurement depended on the true clinical measurement using the tape measure. Pre- and postoperatively, we measured the length of both lower limbs for each patient and classified into; equal, lengthening and shortening groups by comparing the affected side length to the normal side. Finally, we compared the postoperative overall mean LLI between these two techniques. Results: This study revealed that the overall mean of postoperative LLI in the cemented group was – 2.00 while in the cementless group was 3.81. There was no significant statistical difference between LLI developed in these two groups (P value, 0.361). Conclusion: We concluded that, in this study, the utilization of cement in HA surgeries has no impact on the incidence of postoperative LLI. Key words: Cemented, Cementless, Inequality, Leg Length, Limb Length, Hip Arthroplasty, Uncemented.

Adverse drug events (ADEs) are a significant health problem globally, with the emergency department (ED) being an important environment for the detection of ADEs. Data regarding drug-related visits to the ED in Malaysia are currently limited. The aim of this study was to determine factors associated with prescription drug-related ED visits at a teaching hospital. A case-control study was conducted on patients who visited the ED of Hospital Universiti Sains Malaysia over a 7-week period between December 2014 and January 2015. A visit to the ED was considered drug-related if the chief presenting complaint was related to prescription drug use. Data were collected by interviewing patients, and also from the patient’s medical record. Multiple logistic regression was applied to determine the risk factors. Overall, 144 physician-identified patients with drug-related ED visits were considered as cases and 288 patients with non-drug-related complaints were selected as controls. Independent risk factors identified for drug-related ED visits were female sex (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.03–2.71), currently taking regular medication (OR 3.4, 95% CI 1.87–6.05), concurrent comorbidity (OR 2.3, 95% CI 1.28–4.10), a history of drug allergy (OR 5.36, 95% CI 2.30–12.48), and recent hospital admission (OR 2.85, 95% CI 1.23–4.10). Independent risk factors were also associated with the following health problems: diabetes mellitus (OR 6.83, 95% CI 3.30–14.12), central nervous system disorders (OR 9.42, 95% CI 3.08–14.12), and cardiovascular disorders (OR 2.5, 95% CI 1.25–4.79). The determinants of a drug-related ED visit at a teaching hospital are multifactorial. Interventions to prevent future occurrences should focus on those patients at risk.

Behavioral profiling of players in digital games is a key challenge in game analytics, representing a particular challenge in Open-World Games. These games are characterized by large virtual worlds and few restrictions on player affordances. In these games, incorporating the spatial and temporal dimensions of player behavior is necessary when profiling behavior, as these dimensions are important to the playing experience. We present analyses that apply cluster analysis and the DEDICOM decompositional model to profile the behavior of more than 5,000 players of the major commercial title Just Cause 2 integrating both spatio-temporal trails and behavioral metrics. The application of DEDICOM to profile the spatio-temporal behavior of players is demonstrated for the purpose of analysing the entire play history of Just Cause 2 players, but also for the more detailed analysis of a single mission. This showcases the applicability of spatio-temporal profiling to condense player behavior across large sample sizes, across different scales of investigation. The method presented here provides a means to build profiles of player activity in game environments with high degrees of freedom across different scales of analysis - from a small segment to the entire game.

This study has the intention to determine the median time to develop recurrent tuberculosis [TB] in TB patients attending the Chest Clinic at Hospital Raja Perempuan Zainab II [HRPZ II], Kelantan, Malaysia. Records of 114 recurrent TB patients from 1/1/2003-31/12/2009 were analyzed. Kaplan-Meier analysis was used to examine the median time for recurrence of TB. The overall median time to develop TB recurrence in registered TB recurrent patients was six months [95%CI: 4.58, 7.42] after the previous episode. It was found that recipients of Streptomycin (S), Isoniazid (H) and Rifampicin (R) twice weekly (S2H2R2) drug regimen [p=0.026] or daily HR drug regimen [p=0.049] during the continuation phase took a longer duration to develop recurrent TB than non-recipients of these medicines by Kaplan-Meier analysis. Moreover, there also existed a significant time difference [P = 0.006] between the defaulters and non-defaulters of treatment to develop recurrent TB. Patients should take the complete course of therapy, to reduce recurrent TB infection. The drug regimens must contain the two most potent first line drugs Isoniazid [H] and Rifampicin [R] during the continuation phase.

Background: Medication error (ME) posing a challenge to health care systems across the world; which is posing a challenge to health care systems across the world which has increased the risk of death of patient also the consumption cost approximately $42 billion annually in healthcare expenditure. Different types of interventions; including manual physician order reviews and electronic prescription order entry have been proposed as potential solutions to help combat this issue. Objective: To analyze clinical studies on medication errors to assess implemented intervention strategies and measured outcomes, to determine the effective intervention practices with reduced medication errors. Methods: Analysis of meditational error achieved through a systematic review. A search of PubMed was conducted to identify research studies on ME published between May 1960 and June 2017 in English. Result: The types of interventions discussed by computerized physician order entry (CPOE), Pharmacist and computerization, Automatic dispensing cabinets, and bar-coded assisted medication. The number of effective interventions used was [85%, 17/20] decreased the proportion of medication error while [15%, 3/20] interventions, recorded an increase in the proportion of medication error. The CPOE was found to intercept the highest of error [96%] followed by computer-assisted prescription [86%] and Clinical Pharmacist intervention [80%]. Conclusion: Most of the interventions used were found effective in reducing the occurrence of medication errors. The most common intervention used was CPOE by Clinical Pharmacist and Computerization; which was the most effective intervention strategy, followed by Clinical pharmacist, computerization, Automatic dispensing cabinets, and bar-code.

Introduction: Personality is an integration of individuals’ characteristics, benefits them to be successful in their career path. In the field of education, the educators, researchers, and psychologists are on the constant explosion of the tightfisted set of variables that predicts patterns of students’ behaviors, and their association with academic achievement. Objectives: to assess the big five personality traits among medical students, and to find out the relationship between ‘Big Five’ personality traits and academic achievement of undergraduate medical students. Method: A cross-sectional study conducted on122 medical students of year one and two Universiti Sultan from Zainal Abidin, Malaysia. The researchers used a convenient sampling method in the selection of the study sample. Students’ personality traits were assessed using the USM personality inventory USMaP-I scale. Academic scores collected from the academic office. Collected data entered into excel sheet, IBM SPSS version 22 used for the statistical analysis. All the Big Five Personality traits of students positively predicted students overall grade. Of all personality traits, openness, and neuroticism positively related to student’s academic achievement, predicted their overall grade .The student's traits, agreeableness, and conscientiousness showed an association but not with significance. Another dimension extraversion was positively related (r =.150) but not statistically significant. Conclusion: The study results evidence the Big Five Personality Traits has an association with the Academic Performance of Medical Students. Conceptualizing this fact could be useful for the teachers, mentors, and counselors to guide their students. Additionally, students can help themselves in their academic progress and strengthen their career paths.

Background Research suggests that physical activity plays a role to improve health related- quality of life (QoL), however studies examining the association between physical activity and HRQOL are limited in the paediatric literature. The aim of this study is to explore the relationship between physical activity and HRQoL among Malaysian children. Methods Participants (n = 78 normal weight; 78 obese children) aged 9–11 years completed a validated quality of life (QoL) inventory and wore an accelerometer to objectively measure physical activity for 1 week. Results Psychosocial Health domain and Total QoL (all p

Stress among medical students has been well documented as a significant problem. The objective of this study is to compare the stress levels and its associated stressors between public and private university medical students. A cross-sectional study design was carried out using universal sampling in both University Sultan Zainal Abidin (UniSZA) (245) and UCSI University (315) medical students year 1–5, from 2015 till 2016. Data was collected using a self-administered questionnaire including sociodemography, Medical Student Stress Questionnaire and General Health Questionnaire. Data entry and analysis were done using SPSS version 20.0 software. The studies reported a mean age of 23.02 years (SD 1.78) and 21.8 years (SD 1.50) at UCSI University and UniSZA respectively. UCSI University had majority Chinese medical students (52.1%) while UniZSA had majority (66.5) Malay medical students. The stress prevalence was 42.2% and 33.1% among UCSI University and UniZSA medical students respectively. UCSI University had a higher mean stress score of 4.66 (SD 3.4) compared to UniZSA 2.91 (SD 2.98), which was statistically different (p

Introduction: Medical education has been considered highly stressful to medical students. It not only affects medical students’ physical and mental health but chronic stress can impair academic performance, personal and professional development, leading to unsatisfactory patient care. The objective of this study is to compare the coping strategies practiced and its association with stress between medical students from a private and public university. Materials and Methods: This was a cross-sectional study conducted in a public and private university namely, University Sultan Zainal Abidin (UniZSA) and UCSI University (UCSI) respectively. A total of 245 medical students from UniZSA and 315 medical students from UCSI, from year 1 to year 5 participated in this study. This study was carried out between 2015 till 2016. A universal sampling method was used. A self-administered questionnaires comprising of 3 sections namely sociodemographic information, 12 item validated General Health Questionnaire (GHQ-12) and a 28 item validated Brief Cope Inventory was used in this study. Data entry and analysis were done using SPSS version 20.0 software. Results: The prevalence of stress was higher (42.2%) among UCSI University medical students compared to University Sultan Zainal Abidin medical students (33.1%). The commonly practised coping strategies in both universities were religion, active coping, acceptance, planning, and positive reframing. The negative coping strategies behavioural disengagement and substance abuse were the least practised in both universities. The associated coping strategies with stress were denial (?2 5.740; P

Background Data on the prevalence of adverse drug event (ADE)-related emergency department (ED) visits in developing countries are limited. Malaysia is located in South-East Asia, and, to our knowledge, no information exists on ADE-related ED visits. Objective The objective of this study was to determine the prevalence, preventability, severity, and outcome of drug-related ED visits. Methodology A cross-sectional study was conducted in consenting patients who visited the ED of Hospital Universiti Sains Malaysia over a 6-week period. The ED physician on duty determined whether or not the visit was drug related according to set criteria. Other relevant information was extracted from the patient’s medical folder by a clinical pharmacist. Results Of the 434 consenting patients, 133 (30.6 %; 95 % confidence interval [CI] 26–35 %) visits were determined to be ADE related; 55.5 % were considered preventable, 11.3 % possibly preventable, and 33.1 % not preventable. Severity was classed as mild in 1.5 %, moderate in 67.7 %, and severe in 30.8 %. The most common ADEs reported were drug therapeutic failure (55.6 %) and adverse drug reactions (32.3 %). The most frequently implicated drugs were antidiabetics (n = 31; 23.3 %), antihypertensives (n = 28; 21.1 %), antibiotics (n = 13; 9.8 %), and anti-asthmatics (n = 11; 8.3 %). A total of 93 patients (69.9 %) were admitted to the ED for observation, 25 (18.8 %) were discharged immediately after consultation, and 15 (11.3 %) were admitted to the ward through the ED. Conclusion The prevalence of ADE-related ED visits was high; more than one-half of the events were considered preventable and one-third was classed as severe. As such, preventive measures will minimize future occurrences and increase patient safety.