2.Perception towards asthma clinical practice guidelines and appropriateness of prescribing practices--a comparison between government and private doctors.
The Medical journal of Malaysia 2007;62(3):210-3
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
3.Successive objective long-case assessment as a driver of clerkship learning – Evaluation through perception questionnaire
Toh Peng Yeow ; Wai Sun Choo ; Amir S Khir ; Li Cher Loh
International e-Journal of Science, Medicine and Education 2011;5(2):3-11
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.
4.An Investigation Into The Learning Styles, English Proficiency And Assessment Performance Of Medical Students
Toh Peng Yeow ; Mark Kiak Min Tan ; Li-Cher Loh ; Julia Blitz
International e-Journal of Science, Medicine and Education 2010;4(1):7-13
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.
5.PET-CT Imaging In Non-Small Cell Lung Carcinoma – A Review of Cases from A Northern Malaysia Referral Centre
Joni Bing Fei Teoh ; Vikneswary Paniandi ; Fadzilah Hamzah H ; Mohamed Ali Abdul Khader ; Li-Cher Loh
International e-Journal of Science, Medicine and Education 2008;2(2):23-26
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.
6.Assessment Of Basic Practical Skills In An Undergraduate Medical Curriculum
Sambandam Elango ; Ramesh C Jutti ; Palayan Kandasami ; Cheong Lieng Teng ; Li Cher Loh ; Tirathram Motilal
International e-Journal of Science, Medicine and Education 2007;1(1):41-45
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.
7.Sputum Bacteriology And In - Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary - Referral Hospital – A Retrospective Study
Yow-Wen Chin ; Li-Cher Loh ; Thim-Fatt Wong ; Abdul Razak Muttalif
International e-Journal of Science, Medicine and Education 2007;1(2):74-79
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.
9.Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance.
Li-Cher LOH ; Hean-Teik ONG ; Soon-Hoe QUAH
Annals of the Academy of Medicine, Singapore 2007;36(4):281-284
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
10.Hospital outcomes of adult respiratory tract infections with extended-spectrum b-lactamase (ESBL) producing Klebsiella pneumonia.
Li-Cher Loh ; Nor Izran Hanim bt Abdul Samad ; Rosdara Masayuni bt Mohd Sani ; Sree Raman * ; Tarmizi Thayaparan * ; Shalini Kumar
Malaysian Journal of Medical Sciences 2007;14(2):36-40
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