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Author(s):  
Zainul Ikhwan Ahmad Khusairi ◽  
Kartik K ◽  
Ahmad Bilal AN ◽  
Chung WM

Introduction: COVID-19 pandemic is an on-going devastating global event. It starts from December 2019 and is yet to resolve. To date, there are more than 25 million people diagnosed and 850 thousand deaths with COVID-19 (CDC, 2020). Healthcare services throughout the world are facing immense challenges. History taking has been inevitably the most emphasized tool in approaching all patients. However, the usefulness of medical history strongly depends on the patient’s story offered. Incorrect or hidden history may not only bring wrong diagnosis but endanger health care personnel.Objectives: This case series is aimed to describe the importance of clinical history-taking in assessing patients associated with COVID-19 symptoms or history.Methods: Assessment through interview method in taking patient history was used. The focus of history taking was related to health and COVID-19 history. The data collected is a type of secondary data from medical reports of patients who come to receive medical services at the Emergency and Trauma Department, General Public Hospital Taiping, Perak. A total of three cases are taken using the purposive sampling technique. Data is analysed and presented in the form of qualitative data.Results: This study found that the clinical history taking through interview method has successfully identified three patients with positive COVID-19 through assessment conducted.Conclusion: Therefore, the study proved that effective history taking implemented by paramedics was able to identify patients with positive COVID-19 and to plan an appropriate management and help them get discharged without complications. All physicians and other health care practitioners in the Emergency Department or in the clinical ward are also advised to be more competent by increasing their level of knowledge and skills related to assessing patients through effective clinical history taking.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S13


Author(s):  
Tinagaran A/L Karunakaran ◽  
Balamurugan A/L Tangiisuran ◽  
Nur Hafzan Md Hanafiah

Introduction: Worldwide, pharmacists are one of the advocates and practitioners which are commonly overlooked in improving vaccine hesitancy.Objectives: The aim of this study is to explore the vaccination knowledge and perception level as well as the sources of information sought, to support the importance in including the topic within the existing pharmacy curriculum.Methods: A cross sectional study using a validated and tested 43-itemed questionnaire were conducted among pharmacy students in USM. It included 4 domains of demographic data, knowledge on vaccination, perception towards vaccination and source of information on vaccination. Scoring and grouping of knowledge and perception level is based on modified Bloom’s cut-off point. A confidence interval of 95%, p value ≤ 0.05. Chi-square, ANOVA and the Kruskal-Wallis test were considered for the analysis of data.Results: Among 478 eligible pharmacy undergraduates, 311 (65%) participated and completed the questionnaire with a majority of female’s respondents (76.5%). Nearly 72.1% of the students had fair level of knowledge and 90% had good perception level towards vaccination. Online resource shown to be the favourable source of information onvaccination(84.2%). Furthermore, there was a statistically significant knowledge difference across the age, study year and races, (p=.02), (p<0.05) and (p<0.05) respectively. On the other hand, the level of perception shown to have a significant association with nationality (p=0.016), gender (p=0.049) and race(p=0.002).Conclusion: Majority of the students were shown to have fair knowledge and good perception towards vaccination, suggesting the need of implementing vaccination content delivery in the existing curricula to ensure better understanding and practice towards vaccination advocacy.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S28


Author(s):  
Muhammad Farid Bin Zainal Abidin ◽  
Mafeitzeral Bin Mamat ◽  
Chia Peh Wui ◽  
Mohd Syahfadzreen Bin Yunus

Introduction: The district of Semporna, Sabah faced an overwhelming surge of COVID-19 third wave by mid-September 2020. Tawau Hospital services were severely debilitated with the free flowing sick COVID-19 cases referred from Hospital Semporna as its district cluster. This was on top of the usual busy referrals of non-COVID-19 cases especially maternity related.Case Presentation & Discussion: As an ultra-red zone area, all Semporna patients were unfortunately classified as high risk COVID-19 and managed as such to ease clinical decisions. The anaesthesia services in Semporna Hospital’s operating theatre had ceased since 2007. All decisions related to possible intervention of normal labour were referred to Hospital Tawau which is 107 km away. The operating theatre was then prepared with reference to high safety international standards despite the technical drawbacks of old infrastructure facilities. The acquirement of new operation theatre (OT) equipment by Ministry of Health (MOH) due to the pandemic made the balance possible. A thorough discussion and agreement of protocols were made between the major decision makers of clinical departments from both Tawau and Semporna Hospital. A lower segment Caesarean section was performed successfully under regional anaesthesia on the 30th of October 2020 in Semporna Hospital after a 13 years’ hiatus. There were anumber of indirect benefits to the Semporna mothers and hospital with this reactivation.Conclusion: This was indeed a milestone towards upgrading the hospital for specialist services in the near future.This effort has improved the safety and quality of medical services for Semporna patients.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S19


Author(s):  
Zainul Ikhwan Ahmad Khusairi

Introduction: Emergency departments (ED) typically practice a triage system to classify patients into priority levels. A triage system is commonly used in crowded emergency rooms to determine which patient should be seen and treated immediately.Objective: The objective of this study was to evaluate the effectiveness of triaging pathway guidelines for critical cases seen in the Emergency Department during the COVID-19 outbreak.Case Presentation: Emergency Department, Taiping Hospital is practicing a triaging system which consists of two divisions; cases with respiratory symptoms (SARI) and cases without symptoms of respiratory impairment (non-SARI). A patient with snake bite was presented at the Emergency Department, Taiping Hospital with symptoms of numbness at the site of the bite and a complaint of difficulty to open the eyes, while tachycardia was noted. However, no shortness of breath or difficulty in breathing was reported. COVID-19 rapid screening was done and the patient was treated under Red Zone (non-SARI). Luckily, the patient survived and was stable with no reaction observed after treated with Neuro Polyvalent Antivenom 50ml in 500ml normal saline over one hour.Conclusion: The available patient triaging pathway strategy guideline was effectively practiced by paramedics when managing critical cases at the Emergency Department during COVID-19 outbreak. Other emergency departments are advised to practice effective and appropriate triaging pathway strategy guidelines to save patients’ lives.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S15


Author(s):  
Wei Chern Ang ◽  
Jurisma Che Lah ◽  
Nursyafiqah Zulkepli ◽  
Nursyamimi Sukri ◽  
Amalina Rosedi

Introduction: Home Medications Review (HMR) is a continuation of patient care from health facilities to their home to assess patients’ pharmacotherapy by a multidisciplinary team. Bedridden patients were the main group who received this service. To improve the provision of HMR, we need to understand carers’ viewpoints of the current service.Objectives: To explore the carers’ perspectives of HMR conducted by the medical outreach team (MOT) of Hospital Tuanku Fauziah. Methods: This is a qualitative study conducted among carers who were involved in the HMR programme for more than six months. Subjects were recruited by purposive sampling from August 2019 to December 2019. In-depth interviews were audio-recorded at patients’ homes until data saturation and transcribed verbatim. The transcripts then underwent thematic data analysis.Results: Nine carers were interviewed. All participants had a limited understanding of HMR since they were not properly counselled prior to admission to the programme. The convenience of not having to go to the hospital was perceived as the major benefit of the programme. Healthcare providers were welcomed during each visit. Recognising allied health professionals in the MOT possesses a problem for some carers. There was a concern about having to collect newly add-on medications from the hospital. Some participants suggested increasing the frequency of visits and hope for more financial aids.Conclusion: This study proved that carers’ understanding of HMR was generally poor. All carers were satisfied with the current HMR programme provided by the MOT. However, several aspects of our HMR need to be improved. Despite the COVID-19 situation that puts HMR onhold and telemedicine have been adapted, HMR is here to stay in the post-COVID-19 era. This is supported by studies conducted in the pre-COVID-19 era that HMR is more beneficial than telemedicine due to the personal touch of face-to-face encounters.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S24


Author(s):  
Amirah Amiruddin ◽  
Nurul Fitri Mustapa ◽  
Azwanis Abdul Hadi ◽  
Muhammad ‘Adil Zainal Abidin

Introduction: Self-esteem is an essential aspect of wellbeing particularly for medical students who are susceptible to mental disorders. In Islam, self-esteem is built based on both revelation by Allah and human’s effort. With the increasing study in terms of religiosity and self-esteem, the role of religiosity as possible protective factor for Muslim medical students in their life, is a steppingstone towards becoming competent Muslim professionals.Objectives: This study aims to measure the level of self-esteem among medical students and its association with religiosity.Methods: This online cross-sectional study was conducted among 178 International Islamic University Malaysia (IIUM) Kuantan medical students using validated 10-items IIUM Religiosity Scale (IIUMReIS), and 10-items Rosenberg Self-Esteem Scale (RSES). Descriptive statistics was used to measure the level of self-esteem while chi-square, Mann-Whitney U test, Spearman’s correlation, univariate and multivariate logistic regression were used to explore the association between self-esteem with the predictors.Results: More than half of the students (58.5%) have a high level of self-esteem. They scored an average of 35 (IQR = 6) in terms of religiosity. Those with higher religiosity were predicted to have significantly high self-esteem (r = 0.345). Other significant factor includes, frequency of voluntary prayer where daily practice has 0.3 lower odds of having low self-esteem. (95% CI = 0.11, 0.85, p = <0.05)Conclusion: Majority of the students have a high level of self-esteem. Implications of the role of religiosity and the impact of voluntary prayer were suggested. Early and consistent strengthening of self-esteem via motivational, spiritual and religious programs may be advisable.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S27


Author(s):  
Abdul Rashid Abdul Rahman

The year 2020 has been dominated by a communicable disease which most did not see coming and are ill- prepared to handle. While daily headlines the world over are dominated by new cases and death from COVID-19, other major health issues must not take a back seat. As of 30thNovember this year, 357 people have died of COVID-19 in Malaysia,while close to 15,000 Malaysians died of Ischemic Heart Disease (IHD) alone. With IHD and cerebrovascular accident (CVA) being the number 1 and number 3 causes of death (15% and 8% of all death, respectively) our focus on COVID-19 must not distract us from the ‘elephant in the room’. Evidence from UK showed that while hospitalization due to acute myocardial infarction (AMI) has significantly decreased by 50%, out of hospital cardiac arrest has significantly increased by 56%; and in hospital mortality from AMI has increased by at least 35% during the pandemic. Patients are shying away from coming for scheduled follow ups, and there has been a reduction in guideline recommended care for NCD. This is confounded by early scare which suggested that treatment of risk factors for NCDs, especially for hypertension, dyslipidemia, and diabetes, may increase susceptibility to and worsen prognosis for patients with COVID-19. Since COVID-19 is a new entity, latest evidence generated are mainly from observational studies with few clinical trials with the exception of vaccine trials. What do we know about management of NCD in the COVID-era?Since the discovery that SARS-COV-2 virus attached itself to the ACE2 receptors before entering cells, alarm bells were sounded that patients treated with RAAS inhibitors may be susceptible to and have worse prognosis. Withup to 60% of hypertensiveworldwide taking this class of drugs, the concern is understandable. Reassuringly, 6 observational studies from 4 countries and 1 RCT from a 5th country showed this not to be true. Studies from China and Italy showed that those on RAAS inhibitors have better prognosis and this has triggered an RCT which hypothesized that pre-treatment with angiotensin receptor blockers may be beneficial in preventing pulmonary damage in these patients. Another RCT is looking at recombinant human ACE2 as treatment for patients with COVID-19. In diabetic patients, an observational study from New York showed those on statin has reduced mortality compared to non-user and in a large UK based primary care setting there was no increased risk of COVID-19 among patients prescribed SGLT2 inhibitors. The SGLT2 inhibitors have been proven to improve clinical outcome including mortality in diabetics and could be safely used to treat patients during the pandemic. Based on a nationwide retrospective cohort in the UK, overall mortality was higher for diabetics admitted to ICU or HDU and with greatest mortality impact in younger patients.The next few months will see more prospective intervention studies publishedaddressing the various unanswered questions. It is worth remembering that substandard care is responsible for upto 84% of CV death. Hence, we shouldnot let our guards down with NCDs even when the world’s attention is focused on COVID-19.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S10


Author(s):  
Zaitul Akmal AZ ◽  
Salmah N ◽  
ND Ismail ◽  
Muhammad Akmal MN ◽  
Khairatul Nainey K

Introduction: In Malaysia, the rate of adolescents involved in sexual activities has increased and starts at an earlier age. Data from NHMS 2017 showed that 7.3% among surveyed 13 to 17 years-old adolescents have already had sex. The rate of teenage pregnancies is also increasing at 3.7-3.9% between the years 2009 until 2011. Therefore, an effective SRH Programme should be conducted in schools to equip them with adequate knowledge regarding this subject.Methods: A cross-sectional questionnaire survey was conducted among 145 randomly selected secondary school students aged 13 to 15 years old, attending the SRH Programme in a secondary school in Cheras, Selangor, Malaysia. The objective of this programme is to deliver knowledge and promote awareness among adolescents regarding SRH. The programme consists of intervention using adolescent-friendly module and games. A pre- and post-test were given to the participants to evaluate the effectiveness of the programme using the validated SRH questionnaire (Malay version). The questionnaire consists of fourteen and six items for knowledge and attitude, respectively.Results: The result showed an increase in the mean knowledge score (±SD) after the SRH Programme at the school from 7.25 ± 2.44 for pre-test to 9.70 ± 3.17 for post-test. The mean difference in pre- and post-test was 2.45 (95% CI: 2.02, 2.87) and was statistically significant (p<0.001). In terms of attitudes, the majority of the students felt that they have enough knowledge to make a gooddecision regarding sexual reproductive health issues after the SRH programme. However, there was only a small increment with regards to their attitudes on assertiveness.Conclusion: This study demonstrated an increase in the level of knowledge among adolescents in Cheras after the SRH programme using the adolescent-friendly module and games. However, there is no significant change in attitude among adolescents regarding SRH.Future SRH programmes need to be done regularly to instil positive attitudes among adolescents in dealing withsexual reproductive dilemmas.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S20


Author(s):  
Huzairi Sani ◽  
Nada Syazana Zulkufli ◽  
Iman Wahidah ◽  
Nurul Afiqah ◽  
Nur Sabrina ◽  
...  

Introduction: Deafness is the inability to hear or impaired hearing. In 2018, more than 40,000 Malaysians were registered with hearing loss. Sign languages use visualization and facial expression to convey conversational meaning. However not many healthcare workers are able to converse in sign language thus hampering effective communication with deaf patientsObjective: To evaluate the effectiveness of sign language in increasing awareness amongst medical students on healthcare access difficulties faced by the deaf.Methods: Four medical students underwent sign language classes at the Malaysian Federation of Deaf before being formally assessed and certified by an instructor. A video on common questions used in the clinical setting using sign language was then developed and shown to a cohort of 224 medical students in UiTM. Awareness on the importance of sign language amongst the cohort was surveyed before and after watching the video. The four medical students were also assessed on their awareness and communication proficiency before and after attending classes. Post- and pre-test responses were analysed using Wilcoxon signed rank test and paired sample T-test.Results: The number of students who were aware of the importance of sign language in the clinical setting increased from 39.7% (N=89) to 98.2% (N=220) after watching the video. The four medical students’ post-test scores also increased significantly after attending sign language classes (Mean +2.43, p<0.01). Significant improvement in basic knowledge of sign language and ability to demonstrate signs such as self-introduction and gathering medical history were observed (p=0.046). In totality, awareness of the challenges faced by deaf-mute patients when communicating with healthcare workers increased significantly (p=0.046).Conclusion: Sign language is essential in improving communication between deaf patients and healthcare workers. It is therefore imperative that healthcare personnel gain basic skills in sign language to improve communication and provide better medical services to the deaf community.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S11


Author(s):  
Amaluddin Ahmad ◽  
Soe Soe Aye ◽  
Roy RilleraMarzo

Introduction: An exit evaluation study by the final year graduating students was done Just prior to the completion of the third batch of the MBBS program at Asia Metropolitan University (AMU).Objective: (1) To determine whether the MBBS program had enabled the students to (a)attain the eight Program Learning outcomes (PLO); (b)to achieve the eight major competency areas expected upon completion of the program; and (2) To look into the strengths and weaknesses of the program from the graduating final year students’ perspectives.Methods: A descriptive study was done among 18 medical students who were doing senior clerkship posting. A self-administered questionnaire including one open ended question was used for the study. Informed consent was obtained from the participants, assuring them on confidentiality. Data gathered were analysed using SPSS version 23.Results: Most of the students (77%) feel that the program had enabled them to attain each one of the eight Program Learning Outcomes(PLO); between 60-78% achieved competencies in each one of the eight major areas expected at the end of course. The strengths included experienced lecturers, smooth implementation of the program, well designed curriculum while weakness was deficiency in clinical skills, training facilities, number of lecturers, case mix and adequacy of clinical exposure. The weaknesses include readiness to be a self-directed learner.Conclusion: Majority of the students attained each of the eight (PLO) competencies. The strengths were identified and discussed. The study has paved the way for a more detailed indepth study with more samples among the future graduating batches.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S12


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