Objective: One key factor found to be related to creativity is creative self-efficacy. Creative self efficacy (CSE) refers to one’s own conviction in their own ability to produce creative work effectively. The study aims to explore on the predictive values of time management and reading habit on CSE, as well as on the significant difference between gender and CSE. Method: This study (n = 313) is a cross-sectional survey design. The inclusion criteria for the participants are full-time university students studying in Malaysia and aged between 18-25 years old. Data collected was analysed by linear regression, multiple linear regression and independent sample t-Test. Results: Reading habit is a significant positive predictor of CSE. Both daily planning and confidence in long-range planning in time management are significant positive predictors of CSE. However, there is no significant difference between gender in terms of male and female and CSE. Conclusion This study provided evidence on the role of reading habits and time management on creative self-efficacy amongst undergraduate student in Malaysia.
Gender Identity ; Time Management

PURPOSE: We designed a modified technique to perform an advanced procedure using conventional instruments and did not employ specialized single-incision laparoscopic surgery (SILS) port equipment. We compared postoperative results for transumbilical, single-port laparoscopic appendectomy (TUSPLA) and single-incision, 2-port laparoscopic appendectomy (SITPLA). METHODS: This retrospective study enrolled 77 patients who underwent TUSPLA or SITPLA to provide more minimally invasive surgery between May 2017 and April 2018. TUSPLA was performed in 39 patients and 38 underwent SITPLA. In the SITPLA group, two 5-mm trocars were inserted through the umbilicus and an extra puncture site was used for a left-handed instrument. Demographic characteristics, operative data, and postoperative outcomes were collected and compared between the groups. RESULTS: The mean total operative time in the SITPLA group was shorter than in the TUSPLA group (p=0.003). The mean laparoscopic instrumental time was also shorter (p<0.001) in the SITPLA. The number of postoperative analgesics in the SITPLA group was less than in the TUSPLA group (p=0.002). The length of hospital day after surgery was shorter in the SITPLA group than in the TUSPLA group (p=0.008). There were no other significant differences between the groups. CONCLUSION: SITPLA had a shorter operative time, required less pain management, and had a similar cosmetic outcome when compared with TUSPLA.
Analgesics ; Appendectomy ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Operative Time ; Pain Management ; Punctures ; Retrospective Studies ; Surgical Instruments ; Umbilicus

BACKGROUND: Standardized postoperative airway management is essential for patients undergoing anterior cervical spine surgery (ACSS). The paucity of clinical series evaluating these airway complications after ACSS has been resulted in a significant limitation in statistical analyses. METHODS: A retrospective cohort study was performed regarding airway distress (intubation for more than 24 hours or unplanned reintubation within 7 days of operation) developed after ACSS. If prevertebral soft tissue swelling was evident after the operation, patients were managed with prolonged intubation (longer than 24 hours). Preoperative and intraoperative patient data, and postoperative outcome (time to extubation and reintubation) were analyzed. RESULTS: Between 2008 and 2016, a total of 400 ACSS were performed. Of them, 389 patients (97.25%) extubated within 24 hours of surgery without airway complication, but 11 patients (2.75%) showed postoperative airway compromise; 7 patients (1.75%) needed prolonged intubation, while 4 patients (1.00%) required unplanned reintubation. The mean time for extubation were 2.75 hours (range: 0–23 hours) and 50.55 hours (range: 0–250 hours), respectively. Age (P = 0.015), diabetes mellitus (P = 0.003), operative time longer than 5 hours (P = 0.048), and estimated blood loss (EBL) greater than 300 mL (P = 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation. CONCLUSION: In ACSS, postoperative airway compromise is related to both patients and operative factors. We recommend a prolonged intubation for patients who are exposed to these risk factors to perform a safe and effective extubation.
Airway Management ; Cohort Studies ; Diabetes Mellitus ; Humans ; Intubation* ; Operative Time ; Retrospective Studies ; Risk Factors* ; Spine*

PURPOSE: The purpose of this study is to investigate adherence to the clean intermittent catheterization (CIC) and influencing factors on the adherence following a customized intensive education program (CIEP). METHODS: This work is a retrospective descriptive study. The subjects were 226 emptying failure patients who learned in a CIEP from January 2012 to July 2014. The program developed in 2011 and consisted of 1) customized theoretical education; based on the results of urologic tests, underlying disease, or surgery of the patients, 2) hands-on practice until the trainees were able to master the techniques, 3) questions about the process of catheterization and what he/she needs to know. 4) at follow-up, the survey about adherence and barrier to CIC. Clinical characteristics; the level of satisfaction, understanding, and self-confidence; the barrier in medical records were reviewed. RESULTS: The short-term adherence rate (median 22 days) is 87.6% and the long-term adherence rate (median 112 days) is 50.4%. The biggest obstacle is time management. The levels of satisfaction, understanding, and self-confidence are very high. The variable of Income is the only factor that has influence on adherence. CONCLUSION: Despite the CIEP, the adherence rate is relatively low. In addition to the education, emotional and psychological supports and regular follow-up are needed to improve long-term adherence.
Catheterization ; Catheters ; Education ; Follow-Up Studies ; Humans ; Intermittent Urethral Catheterization ; Medical Records ; Patient Compliance ; Retrospective Studies ; Time Management

STUDY DESIGN: Prospective randomized, double-blind controlled trial. PURPOSE: Here, we aim to compare the efficacy and safety of pain control between pre- and postoperative parecoxib administration in patients who have undergone major spine surgery. OVERVIEW OF LITERATURE: Several studies have compared the efficacy of pre- and postoperative administration of parecoxib, which led to inconclusive results owing to variation in operative time. Preincisional parecoxib administration reduces inflammatory response in major spine surgery requiring longer operative time; however, it may not reduce pain as much as parecoxib administration immediately after surgery would. METHODS: Totally, 127 patients who underwent major spine surgery were randomly divided into three groups: pre-group, which received 40 mg parecoxib before skin incision and at 12 and 24 hours after the first dose; post-group, which received the same dose at wound closure and at 12 and 24 hours after the first dose; and control group, which did not receive any parecoxib. Efficacy and safety of parecoxib were measured based on pain score, morphine consumption, and side effects from both morphine and parecoxib at 24 hours after surgery. RESULTS: Initial postoperative pain score, postoperative pain score at rest, and accumulative morphine consumption at 24 hours after surgery were similar between the pre- and post-groups. Despite the significantly lower pain score and morphine consumption in both pre- and post-groups compared with the control group, cumulative morphine consumption at 24 hours after surgery was reduced by approximately 50% in the pre-group and 46% in the post-group compared. Analgesic-related complication incidence was similar in all groups. CONCLUSIONS: The timing of parecoxib administration, either before or after major spinal surgery, did not affect the safety and analgesic efficacy of pain management.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Morphine ; Operative Time ; Orthopedics ; Pain Management ; Pain, Postoperative ; Prospective Studies ; Skin ; Spine ; Wounds and Injuries

PURPOSE: Although medical curricula are now better structured for integration of biomedical sciences and clinical training, most teaching and learning activities still follow the older teacher-centric discipline-specific formats. A newer pedagogical approach, known as Collaborative Learning Cases (CLCs), was adopted in the medical school to facilitate integration and collaborative learning. Before incorporating CLCs into the curriculum of year 1 students, two pilot runs using the action research method was carried out to improve the design of CLCs. METHODS: We employed the four-phase Kemmis and McTaggart's action research spiral in two cycles to improve the design of CLCs. A class of 300 first-year medical students (for both cycles), 11 tutors (first cycle), and 16 tutors (second cycle) were involved in this research. Data was collected using the 5-points Likert scale survey, open-ended questionnaire, and observation. RESULTS: From the data collected, we learned that more effort was required to train the tutors to understand the principles of CLCs and their role in the CLCs sessions. Although action research enables the faculty to improve the design of CLCs, finding the right technology tools to support collaboration and enhance learning during the CLCs remains a challenge. CONCLUSION: The two cycles of action research was effective in helping us design a better learning environment during the CLCs by clarifying tutors' roles, improving group and time management, and meaningful use of technology.
Cooperative Behavior ; Curriculum ; Education ; Health Services Research* ; Humans ; Learning* ; Meaningful Use ; Methods ; Schools, Medical ; Students, Medical ; Time Management

INTRODUCTIONDoor-to-balloon (DTB) time is critical to ST elevation myocardial infarction (STEMI) patients' survival. Although DTB time is reduced with direct cardiovascular laboratory (CVL) activation by emergency physicians, concerns regarding false-positive activation remain. We evaluate false-positive rates before and after direct CVL activation and factors associated with false-positive activations.

MATERIALS AND METHODSThis is a retrospective single centre study of all emergency CVL activation 3 years before and after introduction of direct activation in July 2007. False-positive activation is defined as either: 1) absence of culprit vessel with coronary artery thrombus or ulceration, or 2) presence of chronic total occlusion of culprit vessel, with no cardiac biomarker elevations and no regional wall abnormalities. All false-positive cases were verified by reviewing their coronary angiograms and patient records.

RESULTSA total of 1809 subjects were recruited; 84 (4.64%) identified as false-positives. Incidence of false-positive before and after direct activation was 4.1% and 5.1% respectively, which was not significant (P = 0.315). In multivariate logistic regression analysis, factors associated with false-positive were: female (odds ratio (OR): 2.104 [1.247-3.548], P = 0.005), absence of chest pain (OR: 5.369 [3.024-9.531], P <0.0001) and presence of only left bundle branch block (LBBB) as indication for activation (OR: 65.691 [19.870-217.179], P <0.0001).

CONCLUSIONImprovement in DTB time with direct CVL activation by emergency physicians is not associated with increased false-positive activations. Factors associated with false-positive, especially lack of chest pain or LBBB, can be taken into account to optimise STEMI management.

Bundle-Branch Block ; epidemiology ; Cardiac Catheterization ; Chest Pain ; epidemiology ; Coronary Angiography ; Disease Management ; Emergency Medicine ; Humans ; Logistic Models ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Physicians ; Retrospective Studies ; ST Elevation Myocardial Infarction ; diagnosis ; epidemiology ; therapy ; Sex Factors ; Singapore ; epidemiology ; Time-to-Treatment

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program.
Awards and Prizes ; Demography ; Education, Medical ; Fellowships and Scholarships ; Humans ; Internship and Residency* ; Organization and Administration ; Patient Care ; Reproductive Medicine ; Students, Medical ; Time Management ; Translational Medical Research ; United States ; Writing

Timing of surgery is important for prognosis. In patients with acute abdomen, the urgency means timing of surgery is even more important. However early emergency surgery is often logistically daunting because of constraints on resources such as operating room, supporting anesthesiologist, and nurses. Therefore it is worthwhile reviewing the timing of surgery in the patient with acute abdomen. The authors discuss the ideal time to surgery based on their experience and a review of the literature. For appendicitis and for peptic ulcer perforation, the authors recommend surgery within 24 hours from symptom onset. However, for other acute abdomen disease, evidence for a consensus is not as strong. If a surgeon faces a large number of emergent patients, if resources are limited, the surgeon must decide priorities for surgery. Therefore, an emergency triage system is needed, based on expert opinion and evidence. Although several triage systems are described in the literature, there is some controversy. If we follow a triage system, utilization of resources will be more efficient and acute care surgery might be performed within the ideal time.
Abdomen, Acute* ; Appendicitis ; Consensus ; Emergencies ; Expert Testimony ; Humans ; Operating Rooms ; Peptic Ulcer Perforation ; Prognosis ; Time Management ; Time-to-Treatment ; Triage

PURPOSE: Patients presenting to an emergency department (ED) with pain related complaint continue to experience significant delay to analgesia. This study was conducted in order to evaluate the associations of adequate pain relief with analgesia and time to analgesia with ED length of stay. METHODS: This study was a retrospective analysis of real time data collected from the ED. We included all consecutive patients age 18 years and above with acute painful conditions during May 2013 to June 2013. We evaluated numerical rating scale (NRS) in patients with pain on admission to the ED and re-evaluated NRS at 30 minutes after analgesia administration. Adequate pain relief was defined as reduction of 50% or more of the initial pain score. RESULTS: A total of 560 patients met our inclusion criteria. Mean age was 44.7 years old and 52.7% were men; 13.6% of the patients were admitted with trauma. Among them, there were significant differences in terms of the proportion of male sex and NRS between those with time to analgesia within 30 minutes and beyond. In multivariate logistic analysis, trauma, higher initial NRS and time to analgesia within 30 minutes showed association with adequate pain relief (OR=2.77, 1.14 and 1.84 respectively). CONCLUSION: In our study, male and patients who had higher initial NRS showed association with rapid analgesia administration. In addition, trauma, higher initial NRS, single use of analgesia, chest pain and time to analgesia within 30 minutes showed association with adequate pain relief in the emergency department.
Acute Pain ; Analgesia* ; Chest Pain ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Male ; Pain Management ; Retrospective Studies ; Time Factors