The notion of competency in pre-hospital emergency medical service (EMS) personnel is mainly focused on the professional proficiency that he/she has to provide intervention outside of hospital setting. Consequently, the effectiveness of pre-hospital EMS performance very much depends upon the capability of the personnel at the scene and as well during transport to the definitive care center. The aim of this study is to appraise and explore the competency of pre-hospital care staff and provide strategies for improvement. Methods: A mixed method approach combining the qualitative and quantitative study design. Of 134 staffs only 111(82.84%) returned the questionnaire. Nine semi-structured interviews and two focus group discussions were performed. The main informants were nurses/assistant medical officers, nurse/assistant medical officer administrators, and emergency physicians. Results: From the quantitative finding on the competency of staff handling pre-hospital EMS, all had the essential knowledge and skills. However, most of them reported not having good knowledge and skills for invasive procedures (31%-61%), include giving medications (61%-66%). The qualitative information provided insight about the issues and strategies for the personnel in regards to competency. All the relevant qualitative data were merged into 5 categories relating issues and 5 categories to strategies that could affect the competency of the personnel. Conclusion: Pre-hospital EMS systems need to consider that the competency of pre-hospital EMS personnel has to come along with the responsible attitude of the staff itself, the support of medical direction, clear protocol for guiding them whenever needed, and continuous professional-development courses require them to maintain their professional proficiency.

Introduction: Flood disaster is a natural disaster that has unexpectedly occurred again. Community cooperation in terms of managing flood and focusing on families’ needs has become more systematic. It is important for a household to be prepared in any disaster. One of the preparations that should be done is the stockpiling of emergency supplies or flood supply kits during evacuation. This study aimed to develop a specific disaster kit for households for evacuation during a flood disaster based on cultural context. Methods: Data were collected from 75 key informants from every level of households that really have a great experience during the flood disaster that helping family packing for a living needs before evacuation. The development of the disaster kit based on cultural needs and all their views, needs, experiences, challenges, frustration and happiness was obtained from the interview sessions. Results: There are five themes that emerged from this research related to developing a disaster kit. The themes are community preparedness in dealing with flood disaster, hygiene issues during the flood, inadequate food supply, how the community responds to insufficient water supply, and coping method with illness. After being finalized, there are seven kits: a general supplies kit, documentation kit, emergency food and water supply kit, prayer kit, hygiene kit, basic first aid kit, and baby kit. Conclusion: The development disaster kit was created to help the communities to be more aware and prepared before disaster strikes.

ve To investigate the effect of intravenous cAMP on the myocardial infarct size, the ultrastructure of myocardium and myocardial cell apoptosis and the possible mechanism of myocardial protection affected by cAMP against ischemia /reperfusion (I/R) injury. Methods Forty SD rats of either sex weighing 250-280g were anesthetized with abdominal sodium pentobarbital 4.5mg/100g, tracheotomized and mechanically ventilated (VT = 2ml/100g, RR = 60bpm) . Myocardial I/R was produced by tying and untying of left anterior descending coronary artery. Ischemia lasted 30 min and reperfusion 2h. Rats were randomly divided into 3 groups: control group (n = 8) in which left anterior descending coronary artery was exposed and a piece of silk thread was placed around the artery but not tied; I/R group (n = 16) in which normal saline 1ml was injected into sublingual vein before I/R; cAMP group (n = 16) received intravenous cAMP 1mg/kg 5min before I/R. The animals were then sacrificed and heart was harvested for determination of myocardial infarct size (by TTC) and ultrastructure examination (electron microscope) . Apoptosis was identified by TUNEL and apoptosis index (AI) was obtained. The expression of Fas, Bcl-2 protein was measured by immunohistochemical technique. Results The infarct size was smaller in cAMP group than that in I/R group . Myocardial apoptosis and necrosis were quite obvious in I/R group whereas in cAMP group the ultrastructure of myocardium was fairly normal. The AI in I/R group was significantly higher than that in cAMP group (P 0.05 ) . Conclusions cAMP can protect myocardium from I/R injury by modulating the expression of Fas and Bcl-2 protein and inhibit apoptosis following myocardial I/R.

Stomach ; Rubber ; Latex

Information regarding out of hospital cardiac arrest incidence including outcomes in Malaysia is limited and fragmented. This study aims to identify the incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by pre-hospital personnel in regards to the management of cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining qualitative and quantitative study design was used. Two hundred eighty five (285) pre-hospital care data sheet for out of hospital cardiac arrest during the year of 2011 were examined by using checklists to identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. Based on the overall incidence for out of hospital cardiac arrest cases which occurred in 2011 (n=285), the survival rate was 16.8%. On the adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. All the relevant qualitative data were merged into few categories relating to issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. The essential elements in the handling of out of hospital cardiac arrest by pre-hospital care teamwasto ensure increased survival rates and excellent outcomes. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support, and also to address all other issues highlighted in the qualitative results of this study.

Foreign Bodies

Background: In a nursing programme, the main objective is to produce nursing graduates who can provide comprehensive care and treatment to the community. A good approach to the systematic design of a learning environment can lead to positive outcomes for graduates. The learning environment is more than student-teacher interaction, teaching and learning activities. Good physical structures and facilities provided by the university are important, too. Furthermore, the university must also be concerned about meeting students’ psychosocial and emotional needs. The aim of this study is to measure the learning environment by administering the Dundee Ready Educational Environment Measure (DREEM) questionnaire to students across the four years of the Bachelor of Nursing programme at the Faculty of Nursing, IIUM, and to identify areas for change that may contribute to a more meaningful student learning experience. Methods: The DREEM questionnaire was administered to 105 Bachelor of Nursing students at IIUM. Results: The total mean score on the 50-item DREEM inventory was 120.12 out of a maximum of 200. Student perceptions of learning and their teachers, their academic self, social self and their perception of the atmosphere were all positive. Eight items with low mean scores (less than two) on the DREEM questionnaire were identified as requiring remediation. Conclusion: The implications include the need to create and maintain a supportive environment, in addition to designing and implementing interventions to remedy unsatisfactory elements of the learning environment if effective and successful teaching and learning are to be realised. Thus, specific remedial steps to improve the student learning environment of the Faculty of Nursing, IIUM are described.

Learning environment in the universities plays an important role in producing highly competent graduates especially in nursing profession. Thus, the most important as-pects are the teaching activities and as well as student – teacher interaction in daily environment in the university. To investigate the International Islamic University Malay-sia (IIUM) nursing students experience towards their teachers and to identify the rela-tionship between teaching and students learning perception in their learning environ-ment. This study used quantitative method and utilized two out of five subscales in Dundee Ready Educational Environment Measurement (DREEM). The subscales used were students’ perception of learning (SPoL) , students’ perception of teacher (SPoT) and total items in these both subscales are 12 and 11 items, respectively. The ques-tionnaire results revealed that IIUM nursing students scored 28.54/48.00 in (SPoL) and 28.13/44.00 in (SPoT). Both findings showed the IIUM nursing students’ experience their teachers and the learning environment are moving in towards positive directions. The regression finding was 51% of the total variation in students’ perception of teacher score was explained by students’ perception of learning. Although the overall sub-scales (SPoL) score in the current study falls in the category of a more positive per-ception, 2 out of 12 items were poorly scored by the IIUM nursing students. The re-searcher strongly agrees that listening to the expression of students is an important consideration for an educational institution. The overall mean score for (SPoT) showed that the students perceived their teachers as moving in the right direction. In this pre-sent IIUM study, one item showed a mean score of less then 2.00. As a result, these two subscales most probably should reflect the same outcome such as in their aca-demic performance and experience greatly during their student life on campus. The arising issues from this DREEM study at IIUM embrace the need for the creation of supportive environment as well as designing and implementing interventions to remedy unsatisfactorily elements of the learning environment for more effective and successful teaching and learning to be realised.

To evaluated the histological changes within the tegument of adult Fasciola gigantica (F. gigantica) that led to the gross changes that were visible externally. Methods: The effects of oleoresin extract of myrrh (Mirazid ? ), myrrh volatile oil and triclabendazole sulphoxide (reference drug) on the tegumental structure of adult F. gigantica following treatment in vitro had been determined by light microscopy. Results: The internal changes in the tegument observed in this study were compatible with surface changes seen in the previous scanning electron microscopy study, using the same drugs. The swelling of tegumental syncytium was a particular feature of their action, but its level was much greater with myrrh volatile oil, in which vacuolization of the tegument and loss of spines were observed. Conclusions: The present study demonstrated the fasciocidal properties of Mirazid ? oleoresin extract, and it might be possible to reinforce its fasciocidal activity by increasing its content of myrrh volatile oil.