Expanding the Teaching and Practice of Bioethics in Malaysian Research: Integrating the One Health Approach and Strengthening Ethics Committees The definition of bioethics has evolved beyond its traditional Western-centric framework to embrace the One Health concept, reflecting a more integrated and holistic ethical perspective. Ethical considerations of interconnectedness and interdependence of human, animal, and environmental health in research proposals play an essential role in ethics committees. The Ministry of Health, Malaysia, supports the country in becoming a regional hub for industry-sponsored research. The traditional focus on clinical and biomedical ethics is not sufficient. This commentary discusses the need for increasing expertise in teaching research ethics that includes the One Health concept and justifies the design and development of a national bioethics’ curriculum for higher education institutions. It will address the responsibilities of ethics committees in the context of contract research, research wastage, and protection of vulnerable populations.

Quality Appraisal of Clinical Guidelines for Vulvar Disorders Using the AGREE II Instrument ABSTRACT Introduction This systematic review aims to appraise clinical practice guidelines and consensus statements on the management of common benign vulvar disorders using the AGREE II checklist. Methods A systematic search for articles was conducted employing PubMed, EMBASE, Cochrane, and Science Direct from 1 January 2013 to 31 December 2023. The quality of eighteen practice guidelines was independently assessed by four appraisers using the AGREE II checklist. Results Of the eighteen guidelines assessed, one was classified as “recommended”, sixteen were designated as “recommended with modifications” and one as “not recommended”. Conclusion All guidelines proposed similar management strategies for the selected vulvar disorders with only minor variations. Medical practitioners are encouraged to treat patients in accordance with evidence-based recommendations in these guidelines.

This study evaluates a Massive Open Online Course (MOOC) on Emergency Medicine designed by iEM Education Project and Lecturio, using a validated checklist to assess its usability and user experience. The MOOC received a high score for cognitive connection (>4/5), in four components including interactivity, content and resources, media use, and instructional assessment. However, for learner guidance and support, the score was 2.75/5, indicating that the course did not provide clear instructions on how learners can get support or feedback from teachers when encountering problems in the course. For affective and functional connections, all components received a high overall mean score of more than 4/5. The course was impactful to the users who were in their early clinical years, as they were actively engaged and were motivated to complete the course. However, improvements should be made to better stimulate learning by improving learner feedback and providing space for collaborative learning online. Evaluation of MOOC applying the heuristics of usability and user experience identifies specific components of online learning course apart from rating the severity of acceptance or violation of instructional design principles. The information derived from usability and user experience studies can improve design and delivery of online courses.
User-Centered Design ; Educational Technology ; Emergency Medicine

With the allocation in funding for research, there has been growing interest in studying evidence-based policy formulation and decision-making to account for the funding allocation. By employing a narrative review, this paper focuses on the successes, failures, and challenges in the adoption of the MPOWER strategies in implementing the Tobacco Control Policy in Malaysia. The main objective of this paper is to narrate on the translations of research evidence in the design and implementation of the Tobacco Control Policy in Malaysia. Comparisons are made with developed and developing countries. Literature on tobacco control acts and policies were retrieved from online databases using keywords such as “smoking, tobacco, cigarette, and policy control”. Malaysia has adopted both local and global research evidence in implementing the Tobacco Control Policy and has seen steady progress in reduced prevalence of smoking through the years. Nevertheless, some challenges, including shortage of manpower for the enforcement and innovation of tobacco products, prevail, and more efforts are warranted.
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Sharing of knowledge through Continuing Medical Education (CME) contribute immensely to professional development of skills in clinical medical practice. Thus, the writing of CME articles should adopt an approach that addresses the needs of the readers by attempting to fill gaps in their knowledge, skills, and ethics about clinical care. As such CME articles should be comprehensive and focused on specific areas. The specific learning outcomes should be well defined. In designing and development of such articles, pedagogic principles are to be borne in mind. In this article we outline a guide to writing a CME article, incorporating both the principles of instructional design and directed selflearning. The ideal CME articles will transit through multimedia-enhanced interactive online learning, with greater use of connectivity through the internet. Synchronous and asynchronous learning is in greater need, as distance and online learning are increasingly popular. Authors of CME articles will need to eventually design CME articles to be interactive, enriched with multimedia to engage their readers. Lesson plans employing instructional design principles should aim to promote both instructions for learning and formative assessment ensuring learning have taken place, and outcomes have been achieved. This article describes on how to write effective CME articles for medical journals.

Editorial
Palliative Care

The aim of this systematic review is to compare the vaginalerosion rates in different synthetic materials used insuburethral slings in Tension Free Vaginal Tape (TVT-O/TOT) procedures in management of female stress urinaryincontinence.Methods: PRISMA 2009 framework was adopted for studydesign. Scholarly literature search was done usingMEDLINE, EMBASE, the Cochrane Library and ClinicalTrials.gov using selected keywords. Five articles fulfilled theinclusion and exclusion criteria. Our main outcome ofinterest is to review the ideal properties of the suburethralsling, procedure of insertion and post-surgical complicationfollowing the sling insertion primarily vaginal erosion.Results were compared using one way-ANOVA test andindependent T- test.Results: Total of 1725 subjects were available for analysisin the five studies. Monofilament polypropylene constituted92.5% of the total sample size from one study alone.Polyester (n= 16/51) causes higher incidence rate of vaginalerosion compared to monofilament polypropylene (31.4 vs.,4.7; p = 0.01). There was no difference in the vaginal erosionrate between monofilament polypropylene and multifilamentpolypropylene (4.7 vs, 14.1; p=0.055) as well as betweenmultifilament polypropylene and polyester (14.1 vs, 31.4;p=0.068). Although there was a marginally lower rate ofvaginal erosion in TVT-O over TVT, the difference was notsignificant. (5.6 vs., 6.4, p=0.468). Common presentations ofvaginal erosion were vaginal discharge, perineal pain anddyspareunia. Conclusion: Given the limited sample size, polyester slingmaterial appears to cause higher rates of vaginal erosion.No difference in erosion rate was seen between TVT andTVT-O.

Neuroendocrine carcinoma of the female reproductive tract are a heterogeneous group of rare neoplasms posing both diagnostic and therapeutic challenges. The recent classification by WHO includes neuroendocrine carcinomas (NECs) and neuroendocrine tumours (NETs). NECs are the poorly differentiated small cell carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), while well-differentiated NETs include typical carcinoids (TC) and atypical carcinoids (AC). Majority of these tumours have an aggressive clinical course and published data is supportive of multi-modal therapeutic strategies. Etoposide/platinum based chemotherapy is commonly advocated. Histopathological categorisation and diagnosis are paramount to guide therapy. Well-differentiated carcinoid and atypical carcinoid tumours should be managed similar to gastroenteropancreatic neuroendocrine tumours. This review discusses the current classification, clinicpathologic characteristics and advances in the diagnostic evaluation and the treatment options of neuroendocrine carcinoma of the cervix.
Carcinoma, Neuroendocrine ; Carcinoid Tumor