MALAYSIAN ; Pneumonia ; Community

A self-answered, anonymously completed, nationwide questionnaire survey was conducted between June 2002 and May 2003 among Malaysian doctors through post and at medical meetings. Findings based on 116 government and 110 private doctors who satisfactorily completed the forms (effective respondent rate: 30.1%) showed that more than 70% of government and private doctors claimed familiarity with asthma CPGs but proportionately more private doctors considered them "unworkable" and were reluctant to adopt them in their practice setting, quoting cost as the primary reason. Between those who frequently adopted the CPGs and those who did not, there was an equally high proportion of inappropriate prescribing. Despite the shortcomings of such a survey, our findings suggest that medicinal cost and practitioner's prescribing practices are important in the acceptance and execution of asthma CPGs recommendations.
private ; Asthma ; appropriateness ; guiding characteristics ; Cost aspects

Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome. Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability. Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation. Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Appreciation of learning styles can be of use to help both educators and students to enhance the effectiveness of an educational experience. It has been noticed that some students at this College are not very good at expressing themselves in either written or spoken English. Our study aimed to identify the student’s learning styles; assess whether there is any correlation between learning style, baseline demographic data and self rated proficiency in English language; and assess their associations with the assessment performance. A group of third year medical students voluntarily participated in a questionnaire study to provide us with their learning styles, demographic information and self-rated proficiency in English language. This data was compared to the students’ performance in the assessment at the end of their junior clinical rotations. This cohort of students (60% Malay, 35% Chinese and 5% Indian) who were mostly visual learners, considered themselves proficient in English. Students with predominantly Visual learning styles and those with poorer English, score significantly lower during their clinical long case examinations. These two predictors appear to be independent of each other. These results may suggest that our current teaching modalities may disadvantage students with predominant visual learning styles. It also suggests that the long case clinical examination may favour those with more verbal learning styles.

Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed. Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma. Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy. Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis. Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.

Introduction: Health educators and accrediting bodies have defined objectives and competencies that medical students need to acquire to become a safe doctor. There is no report in Malaysia, about the ability of medical students to perform some of the basic surgical skills before entering the houseman ship. The aim of this study is to determine whether the teaching/ learning methods of practical skills in our undergraduate program have been effective in imparting the desired level of competencies in these skills. Methods: A list of basic practical skills that students should be competent has been identified. These skills are taught in a structured way and assessed as part of the composite end- of- semester examination. Practical skills stations form part of an Objective structured practical examination (OSPE). Results: The results of 244 students who participated in three ends of semester examinations were analyzed. The mean score for the practical skills stations were higher than the mean OSPE (of all 18 stations) and overall score (of the written, practical and clinical examination). However the failure rate in the practical skills stations is higher in most of the stations (7 out of 8 stations) compared to overall failure rates. Conclusions: In spite of the formal skills training many students failed to demonstrate the desired level of competencies in these stations. Assessment of practical skills as part of overall composite examination may not be effective in ensuring that all students have achieved the required level of competency. Practical skills should be assessed through dedicated formative assessments to make sure that all the students acquire the required competencies.

Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics. Methods : From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed. Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/ tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems. Conclusion : In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/ sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.

Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in ‘ESBL’ than in ‘non-ESBL’ group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72-7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians.
Extended-spectrum beta lactamase ; Hospitals ; Adult ; Respiratory ; lower case pea

INTRODUCTIONMedical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

MATERIALS AND METHODSTo study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

RESULTSOf the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

CONCLUSIONOur findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.

Adult ; Attitude of Health Personnel ; Congresses as Topic ; utilization ; Education, Medical, Continuing ; methods ; Evidence-Based Medicine ; education ; Family Practice ; education ; standards ; Female ; Health Care Surveys ; Humans ; Malaysia ; Male ; Middle Aged ; Periodicals as Topic ; utilization ; Societies, Medical ; Surveys and Questionnaires

Curriculum ; Education, Medical ; methods ; standards ; Teaching ; methods