A good quality leader is vital in ensuring effective and efficient services rendered to patients. However, as to date, little is known on the leadership styles of managers in Military Hospitals in Malaysia and the region. The aim of this cross-sectional study was to determine the leadership styles and identify the influencing factors, among Military and Non-Military managers in five Military Hospitals in Malaysia. A pre-tested 20-item questionnaire was distributed to eligible managers in the hospitals. Based on the total score, the leadership style of managers was classified into Transformational (TS) and Non-Transformational style (N-TS). Among the 501 respondents, 375 (74.9%) of them were Non-military managers and 126 (25.1%) of them were Military managers. 46.8% (n=59) of the managers with military background practiced TS while only 27.7% (n=104) of Non-military managers have TS (X2 =15.662; p <0.001). Managers aged 40 years and above, male, with higher educational level, served longer in the service, attended in-service training and participated in other capacity building activities were more likely to practice TS. Analysis using stepwise multiple logistic regressions proved that predictors of TS style are educational level (AOR=2.319; 95% CI=1.300,4.134), working experience (AOR=1.075; 95% CI=1.049,1.102), Military managers (AOR=1.759; 95% CI=1.104,2.802) and attended in-service training (AOR=2.070; 95% CI=1.369,3.129). In conclusion, the Military Hospitals have the benefit of being managed by Military managers that practice TS. Educational level and in-service training are two most important elements that influence the practice TS among the managers in these Military Hospitals.

Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Critical Pathways ; Quality of Health Care ; Evidence-Based Medicine ; Health Care Costs ; Interdisciplinary Communication

The knowledge and beliefs on the presence of fluoride in drinking water, its purpose and the associated health risks aids in equate water fluoridation and effective prevention programs. Water fluoridation is a safe, effective, and necessary method where adequate doses of fluoride is added into drinking water supplies with the target of assisting in tooth restoration and preventing tooth decay and dental caries. Therefore, this study identifies the level of knowledge and perception of fluoride in drinking water among residents living in Precinct 9, Putrajaya Methods: A cross-sectional, self-administered online questionnaire was used to examine knowledge and perception of fluoride in drinking water of 240 Precinct 9 residents. Descriptive analysis was applied for socio-demographic data and Chi-square was used to compare discrete data. All data obtained were further analyzed using SPSS Version 23.0. Results: The highest frequency (percentage) of residents were 213 (88.8%), aged 18-64 years old, 141 (58.8%) female, 214 (89.2%) with tertiary education background and 125 (51.1%) of them lived in Precinct 9 for more than 10 years. Of all participants, 137 (57.1%) and 83 (34.6%) have poor knowledge and medium perception regarding fluoride in drinking water respectively. There was a significant association between those with higher education level with knowledge (p=0.02) and perception (p=0.005) where they were more likely to know about overall fluoride in drinking water. Conclusion: Most participants had limited knowledge and negative perception of fluoride beyond a general sense it was beneficial. It appears that in moving forward to receive the water fluoridation support will need to attend to the challenge of anti-fluoride sentiment influence.

Hamman’s syndrome by definition is spontaneous pneumomediastinum with the exclusion of thoracic trauma or iatrogenic cause. It is rare and is more common in adolescence male. Amongst the risk factors are underlying lung condition such as asthma and interstitial lung disease, drug inhalation and parturient woman. Patient usually presents with sudden onset of shortness of breath and chest pain with subcutaneous emphysema on examination. The diagnosis is confirmed with chest radiograph. The prognosis of Hamman’s syndrome is excellent. Most cases are self-limiting and resolve spontaneously. However, Hamman’s syndrome is a poorly recognised disease due to its rarity. Therefore, the patient may be subjected to misdiagnosis and treatment. This is a case report of Hamman’s syndrome misdiagnosed and treated as pneumothorax. The objective of this case report is to highlight the importance of differentiating this benign syndrome with life threatening differentials which may have similar clinical presentation. Thus, avoiding unnecessary costly investigation, treatment and invasive procedures.

Introduction: Total knee arthroplasty (TKA) commonly cause physical impairments, which necessitate physiotherapy post-operatively. Low-intensity pulsed ultrasound is an adjuvant treatment to conventional physiotherapy; however, its effects on TKA recovery require further investigation. The study aimed to ascertain the outcome of adding low-intensity pulsed ultrasound therapy into conventional physiotherapy on recovery from physical impairments after TKA. Methods: This assessor-blinded quasi-experimental study was conducted in a tertiary medical centre in Central Malaysia. Patients with TKA due to grade III and IV knee osteoarthritis (Kellgren-Lawrence grading system) were alternately allocated into either an experimental group (n=10) or a control group (n=10). Other than low-intensity pulsed ultrasound as received by the experimental group’s participants, the two groups received the same amount and content of conventional physiotherapy. Participants’ pain, knee swelling, active knee flexion range, and quadriceps strength were assessed at baseline, week 1 of the intervention, and the 1-week follow-up. The two interventions’ effects were analysed using a mixed model ANOVA. Results: The pain score and knee swelling decreased (P<0.05), while the knee flexion range and quadriceps strength increased significantly (P<0.001) after both interventions. The experimental group had a significantly lower pain score [3.07(2.18) at visual analogue scale] and a greater active knee flexion range [80.48(26.42) degrees] compared to the control group [pain score=4.29(1.54); knee flexion=67.00(25.15) degrees] following the interventions. There were no significant interaction effects for all outcomes. Conclusion: The combination of low-intensity pulsed ultrasound into a conventional physiotherapy program demonstrated more promising results in pain alleviation and knee motion recovery following TKA.

Introduction: COVID-19 is a disease caused by a new strain of coronavirus spreading rapidly over the globe, and the older population has had a larger impact as the fatality rate increases with age. This pandemic caused them to reduce their physical activity (PA). COVID-19 also resulted in food supply disruption and led to unhealthy dietary changes, which are usually associated with weight gain and affecting the body mass index (BMI). PA and BMI can influence the quality of life (QoL) of the older people. Therefore, this study aimed to determine the association between PA, BMI, and QoL amongst the older people in Malaysia during COVID-19. Methods: A cross-sectional study was conducted amongst community-dwelling older people from all states in Malaysia. An online survey consisting of self-reported anthropometry, Global Physical Activity Questionnaire- Malay version (GPAQ-M) and Short Form-36 Health (SF-36) Survey were collected. Statistical analysis chi-square test was used to identify the association between BMI, PA, and QoL. Results: This study included data from 180 individuals with a median age of 64.0 ± 9.8 years. The results showed that participants aged 60-69 years were significantly associated with better QoL, meanwhile, those who practice low PA levels were significantly associated with poor QoL. Conclusion: The findings revealed that age and PA were associated with QoL. Thus, the healthcare profession must emphasise regular PA to accomplish a better QoL amongst older people in the future.