ith recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. 1 Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. 2 The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making
Education, Medical

The incidence of cancer in Malaysia is rising alarmingly and newly qualified doctors will be expected to be competent in the basic management of cancer patients. However, the opportunity to gain experience in oncology management will remain limited unless these students are stationed in an oncology unit which is solely dedicated to the treatment of such patients. Therefore, it is essential that undergraduate medical school training equips students with a sound knowledgebase, so that they can confidently manage basic oncological conditions appropriately. With the many private and local medical universities across the country, it is important that oncology training be standardized and reflective of the local resources available, and government health policies. As a result, having a standardized curriculum would help create a framework whereby competencies in cancer management would be accurately assessed.

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS). Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test. Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts. Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.

The presence of cutaneous metastases in squamous cell carcinomas of the head and neck (SCCHN) is rare and associated with a dismal prognosis. It is vital to distinguish these lesions from direct invasion of the skin by SCCHN or primary cutaneous malignancies as the prognosis is vastly different and so is the management. In this case report, we present four cases of cutaneous metastases and also briefly review the literature pertaining to this phenomenon.

Abstract: Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.

Male breast cancer accounts for only 1% of cancers in men and 1% of breast cancers. Cutaneous metastases occur less than 10% of all patients with visceral malignancies and are considered a rare and late event in progression of metastatic disease. A 45-year-old man presented with a lump in the left breast which was confirmed to be infiltrating ductal carcinoma. He underwent a left mastectomy and axillary clearance followed by chemotherapy and radiotherapy to the left chest wall. However, he was non-compliant to adjuvant tamoxifen due to hot flushes. One year later, he presented with biopsy proven cutaneous metastases. Initially he had complete excision of the lesions, however, two months later more skin lesions appeared predominantly over the chest wall and back. Hormonal therapy failed to control the metastases as such he was treated with systemic chemotherapy. He is currently on third line chemotherapy.