SUMMARY Introduction: Aimed at providing integrated multi-level crisis intervention to women experiencing violence such as rape, One Stop Crisis Centre (OSCC) in Malaysia is often located in the emergency department. Hence, it is imperative that emergency department healthcare providers possess adequate knowledge and acceptable attitudes and practices to ensure the smooth running of an efficient OSCC work process. Method: To study the knowledge, attitude and practice of rape management in OSCC among four groups of healthcare providers in the emergency department [i.e., the emergency medicine doctors (EDs), the staff nurses (SNs), the medical assistants (MAs) and the hospital attendants (HAs)], a selfadministered questionnaire in the form of Likert scale was conducted from January to October 2013. Correct or favourable responses were scored appropriately. Results: Out of the 159 participants invited, 110 responded (69.2% response rate). As all data sets in the Knowledge, Attitude and Practice sections are non-parametric, KruskalWallis test was performed. Homogeneity of variance was verified using non-parametric Levene test. In all three sections, there are statistically significant differences in scores obtained among the four groups of healthcare providers with H(3) = 16.0, p<0.001 for Knowledge, H(3) = 27.1, p<0.001 for Attitude and H(3) = 15.8, p<0.001 for Practice sections. Generally, the SNs obtained the highest mean rank score in the knowledge and practice sections but the EDs obtained the highest mean rank score in the attitude section. Some of the responses implied that our healthcare providers have the victim-blaming tendency that can negatively impact the victims. Conclusion: Healthcare providers must not only have adequate knowledge but also the non-judgemental attitude towards victims in OSCC.
Emergency Service, Hospital ; Sex Offenses ; Rape

Animals ; Calcium ; metabolism ; Cell Line ; Cricetinae ; Cricetulus ; Dose-Response Relationship, Drug ; Fibroblasts ; drug effects ; metabolism ; Vehicle Emissions

This short review explores the current status of cardiopulmonary resuscitation in Malaysia and highlights some of the factors that have a negative impact on its rate of success. Absence of a unifying body such as a national resuscitation council results in non-uniformity in the practice and teaching of cardiopulmonary resuscitation. In the out-of-hospital setting, there is the lack of basic skills and knowledge in performing bystander cardiopulmonary resuscitation as well as using an automated external defibrillator among the Malaysian public. The ambulance response time is also a significant negative factor. In the in-hospital setting, often times, resuscitation is first attended by junior doctors or nurses lacking in the skill and experience needed. Resuscitation trolleys were often inadequately equipped.

INTRODUCTIONFamily presence (FP) during resuscitation is an increasingly favoured trend, as it affords many benefits to the critically ill patient's family members. However, a previously conducted study showed that only 15.8% of surveyed Malaysian healthcare staff supported FP during resuscitation.

METHODSThis cross-sectional study used a bilingual self-administered questionnaire to examine the attitudes and perceptions of the general Malaysian public toward the presence of family members during resuscitation of their loved ones. The questionnaires were randomly distributed to Malaysians in three different states and in the federal territory of Kuala Lumpur.

RESULTSOut of a total of 190 survey forms distributed, 184 responses were included for analysis. Of the 184 respondents, 140 (76.1%) indicated that they favoured FP during resuscitation. The most common reason cited was that FP during resuscitation provides family members with the assurance that everything possible had been done for their loved ones (n = 157, 85.3%). Respondents who had terminal illnesses were more likely to favour FP during resuscitation than those who did not, and this was statistically significant (95.0% vs. 73.8%; p = 0.04).

CONCLUSIONFP during resuscitation was favoured by a higher percentage of the general Malaysian public as compared to Malaysian healthcare staff. This could be due to differences in concerns regarding the resuscitation process between members of the public and healthcare staff.

Attitude of Health Personnel ; Attitude to Health ; Critical Illness ; Cross-Sectional Studies ; Family ; psychology ; Humans ; Malaysia ; Perception ; Resuscitation ; methods ; Surveys and Questionnaires

INTRODUCTIONThe use of intranasal fentanyl as an alternative type of analgesia has been shown to be effective in paediatric populations and prehospital settings. There are a limited number of studies on the use of intranasal fentanyl in adult patients in emergency settings.

METHODSAn open-label study was conducted to evaluate the effectiveness of the addition of 1.5 mcg/kg intranasal fentanyl to 2 mg/kg intravenous tramadol (fentanyl + tramadol arm, n = 10) as compared to the administration of 2 mg/kg intravenous tramadol alone (tramadol-only arm, n = 10) in adult patients with moderate to severe pain due to acute musculoskeletal injuries.

RESULTSWhen analysed using the independent t-test, the difference between the mean visual analogue scale scores pre-intervention and ten minutes post-intervention was 29.8 ± 8.4 mm in the fentanyl + tramadol arm and 19.6 ± 9.7 mm in the tramadol-only arm (t[18] = 2.515, p = 0.022, 95% confidence interval 1.68-18.72 mm). A statistically significant, albeit transient, reduction in the ten-minute post-intervention mean arterial pressure was noted in the fentanyl + tramadol arm as compared to the tramadol-only arm (13.35 mmHg vs. 7.65 mmHg; using Mann-Whitney U test with U-value 21.5, p = 0.029, r = 0.48). There was a higher incidence of transient dizziness ten minutes after intervention among the patients in the fentanyl + tramadol arm.

CONCLUSIONAlthough effective, intranasal fentanyl may not be appropriate for routine use in adult patients, as it could result in a significant reduction in blood pressure.

INTRODUCTIONMetacognition is a cognitive debiasing strategy that clinicians can use to deliberately detach themselves from the immediate context of a clinical decision, which allows them to reflect upon the thinking process. However, cognitive debiasing strategies are often most needed when the clinician cannot afford the time to use them. A mnemonic checklist known as TWED (T = threat, W = what else, E = evidence and D = dispositional factors) was recently created to facilitate metacognition. This study explores the hypothesis that the TWED checklist improves the ability of medical students to make better clinical decisions.

METHODSTwo groups of final-year medical students from Universiti Sains Malaysia, Malaysia, were recruited to participate in this quasi-experimental study. The intervention group (n = 21) received educational intervention that introduced the TWED checklist, while the control group (n = 19) received a tutorial on basic electrocardiography. Post-intervention, both groups received a similar assessment on clinical decision-making based on five case scenarios.

RESULTSThe mean score of the intervention group was significantly higher than that of the control group (18.50 ± 4.45 marks vs. 12.50 ± 2.84 marks, p < 0.001). In three of the five case scenarios, students in the intervention group obtained higher scores than those in the control group.

CONCLUSIONThe results of this study support the use of the TWED checklist to facilitate metacognition in clinical decision-making.

Adult ; Checklist ; Clinical Decision-Making ; methods ; Education, Medical ; methods ; Educational Measurement ; Female ; Humans ; Malaysia ; Male ; Metacognition ; Prejudice ; Program Evaluation ; Students, Medical ; Universities ; Young Adult

BACKGROUND: The balloon dilatation technique plays an important role in the correction of kyphosis. A balloon catheter can enlarge the spinal cavity in kyphoplasty followed by injection of bone cement under low pressure to lay a foundation for the stability of the spine. OBJECTIVE: To explore the feasibility of balloon dilation with injectable calcium sulfate cement for tibial plateau fractures and to analyze its clinical effect. METHODS: Twenty-four upper tibia specimens of the adults were taken to make the Schatzker Ⅲ collapsed fracture model of the tibial plateau. Then, these specimens were randomized into three groups: the standard group was subjected to poking reduction with autologus bone grafting and screw internal fixation, the bone cement group was inflated with balloon dilatation followed by calcium sulfate cement injection, and the combined group was treated with fixation with cancellous bone screws and balloon dilatation followed by injection of calcium sulfate cement. The general situation of reduction and fixation was observed and the reduction effect was measured. RESULTS AND CONCLUSION: (1) Fixation effect in the model: All three models were well reset, and the average displacement of the standard group, the simple bone cement group and the bone cement screw group was (-0.22±0.62), (-0.23±0.67), and (-0.20±0.69) mm, respectively. There was no significant difference in the displacement between the three groups (P ＞ 0.05). (2) Clinical application: One case of Schatzker type Ⅱ fracture of the left tibial plateau was treated with cancellous bone screw fixation and balloon dilatation followed by injection of calcium sulfate cement. X-ray results showed calcium sulfate cement was visible at 3 postoperative days. At 30 postoperative days, the patient presented with good joint range of motion, and the calcium sulfate was partially absorbed on the X-ray film. At 60 postoperative days, the patient appeared to have no joint extension disorder, and fracture healing and absorption of calcium sulfate as shown by X-rays. To conclude, the balloon dilation with injectable calcium sulfate cement for the treatment of tibial plateau fracture is feasible and has clinical value.

Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.
Acute Coronary Syndrome ; Emergency Service, Hospital