Diabetes Mellitus and Diet: Few Important Facts to Ponder / Jurnal Sains Kesihatan Malaysia

Diabetes mellitus (DM) is a metabolic disease which is characterized by hyperglycemia. There is either disturbance in insulin secretion or defective insulin action or even a combination of both. Usually, there are few confounding factors like genetic, obesity, sedentary life style, atherosclerosis, and even faulty dietary habits which lead or aggravate DM. Usually, the individual does not care and often the complications resulting from hyperglycaemia are fatal. Complications in DM involve the cardiovascular, musculoskeletal, endocrine, renal and neurological systems in the body. Treatment of diabetic complications is not only costly but it is also a burden on the affected families. The present review discusses the challenges faced in DM with special concern on diet and food habits. Knowledge of proper food consumption may also help an individual combat complication in DM and reduce the mortality and morbidity.

Evaluation of staff education on ventilator bundle compliance in university Kebangsaan Malaysia medical centre [UKMMC] intensive care unit [ICU]

Ventilator associated pneumonia [VAP] has been associated with high morbidity and mortality rates especially in critically ill patients. Implementing the "ventilator bundle" series of interventions serves a pivotal role in reducing the incidence of VAP. This study was carried out to review compliance of the staff in UKMMC ICU towards ventilator bundle from August 2010 to March 2011. All medical and nursing staffs in ICU were given education by means of lectures, pamphlets, posters, and refresher sessions which were implemented in between two periods of assessment Compliance was assessed on daily basis at random throughout a 140-day course divided into 70 pre-educational days and 70 post-educational days. Pre-educational overall compliance achieved was 38.4%. Compliance of individual component was: [1] head of bed [HOB] > 30 degrees: 43.6%, [2] Peptic ulcer disease [PUD] prophylaxis: 88.6% [3] Deep venous thrombosis [DVT] prophylaxis: 86.7% [4] Sedation vacation: 98.1% [5] Oral care: 96.7%. Post-educational overall compliance achieved was 65.0% with each individual component achieving 67.6%, 97.7%, 89.6%, 97.4%, and 99.0% respectively. There were statistically significant increases [p<0.05] in overall compliance and 3 individual components i.e. HOB elevation, PUD prophylaxis and oral care. Implementation of education had resulted in improved compliance of some, but not all components of the ventilator bundle. Continuous staff education is recommended to ensure further improvement and maintenance in compliance amongst the multidisciplinary team who manage patients in ICU

Nurses' decision making skill in the clinical nursing setting of a tertiary hospital

Clinical decision making in nursing practice is a systematic process involves in identifying problems to ensure optimum delivery of patient care. The study aimed to examine the nurses' decision-making skill in the clinical nursing setting of a tertiary hospital. Ninety three respondents were recruited in this study using Jenkins Clinical Decision Making in Nursing Scale [CDMNS]. The four subscales of CDMS were: search for alternatives and options [mean of 25.99 +/- 3.049]; canvassing for objectives and values [mean of 27.76 +/- 31.50]; evaluation and re-evaluation of consequences [mean of 25.89 +/- 4.437] and search for information and unbiased assimilation of new information [mean of 27.54 +/- 3.939]. There were significant differences between the respondents' marital status with CDMNS subscale of canvassing for objectives and values [t=2.916, p value <.05] and respondents' satisfaction with CDMNS subscale of evaluation and reevaluation of consequences [t =2.932, p value <.05]. Significant differences existed between respondents academic qualifications with CDMNS subscale of evaluation and re-evaluation of consequences [F=6.649, p value< .05] and search for information and unbiased assimilation of new information [F = 6.0009, p value <.05]. Developing decision-making skills are essential in translating theoretical nursing knowledge to clinical practice

Anxiety and depression in patients with coronary heart disease: a study in a tertiary hospital

Anxiety and depression could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease [CHD]. The aim of this study was to investigate the incidence of anxiety and depression in patients with acute CHD. In a period from March to December 2008, the views of 108 CHD patients, hospitalized in a tertiary hospital, were solicited using Hospital Anxiety and Depression hospital, were solicited using Hospital Anxiety and Depression Scale [HADS] and sociodemographic questionnaires. Patients with CHD had a low level anxiety and depression scores. There was significant differences in the total HADS score of participants stratified for marital status [P=0.027] or co-morbidity of diseases [P=0.012]. Also, there were significant differences in the scores of depression subscale stratified for marital status [P=0.021] or co-morbidity of disease [P=0.007]. However, there was no significant difference between the total HADS score or depression subscale score of the participants stratified based on age, gender, race, education, or income. Moreover, unmarried CHD respondents possessed higher depression level compared to the married respondents, and CHD respondents with co-morbid diseases showed a high level of depression. The findings might be taken as evidence to suggest that CHD patients should be evaluated early for the detection of anxiety and depression for appropriate referral and support

Recollections Expressed by Mechanically Ventilated Patients of Intensive Care Unit (ICU), Hospital Universiti Kebangsaan Malaysia (HUKM)

Ventilated patients who require intensive care unit (ICU) treatment may encounter unpleasant experiences. These experiences may include factual incidents and delusional memories of ICU such as dreams, hallucinations and frightening experiences. A cross sectional study using “Intensive Care Experience Questionnaire” consisted of four domains: awareness of surrounding, frightening experiences, recall of experience and satisfaction with nursing care. Forty five participants who fulfilled the inclusion criteria were recruited in this study. This study was conducted in ICU of HUKM from January to March 2006. Results showed that 20 respondents (44%) were aware of their surrounding and 31 respondents (69%) reported frightening experiences. Majority of respondents (43 respondents, 96%) reported satisfaction with the delivery of nursing care. There was positive correlation between awareness of surrounding and their abilities to recall their experiences (p<0.05). Patients’ awareness of surrounding achieved the strongest statistical significance as a contribution to the prediction of their abilities to recall their experiences with beta coefficient value of 0.353 and p<0.05. The finding of this study permits nurses to see the problems of mechanically ventilated patients through reports of unpleasant recollections by the patients themselves. Patients reported frustrations in their attempts to make their needs known. Although they are on sedation, they are aware of all unpleasant events occurring in the ICU

A Study of Patients’ Satisfaction with the Emergency Department (ED) of Hospital Universiti Kebangsaan Malaysia (HUKM)

Patients’ satisfaction is of critical interest to all healthcare providers. Satisfied patients are more likely to seek health care and to comply with prescribed treatment regimes. The objective of the study was to identify factors that influence patient satisfaction with Emergency Department HUKM (ED HUKM). This study was conducted at ED HUKM from January 2007 till March 2007. A convenience sample of 100 participants was recruited from triage 4. The Davis Consumer Emergency Care Satisfaction Scale (CECSS) was adopted and modified. It consists of 19 questions; used a 5 point, Likert type scale of 1 to 5 (1= completely disagree and 5= completely agree) to measure patient satisfaction with triage, health care providers caring behaviours and health teaching. Results showed that 75 participants (75%) were satisfied. There were no significant difference found between male and female patients with total CESCC scores (t=0.308, p values >0.05). Pearson product moment correlation coefficients showed a positive relationship between total and subscale patient satisfaction scores, caring scores (r=0.905, p value <0.05) and teaching scores (r=0.695, p < 0.05). Overall, patients were satisfied with services at the ED HUKM. Patients’ satisfaction remains as an important quality outcome measure of emergency care in any hospital.

A Study of House Officers in a Teaching Hospital on Knowledge, Perception of Skills and Confidence Level in Performing CPR

Cardio-pulmonary Resuscitation (CPR) is important and should be mastered by House Officers (HO). House officers who have just completed their studies are assigned to acute medical and surgical wards. If a patient in the ward has a cardiac arrest (CA), these doctors are usually the first to attend. Therefore an HO must be confident with CPR skills. They must be competent in performing CPR. The authors assessed 26 new HOs from Universiti Kebangsaan Malaysia Hospital (HUKM) with respect to their self-perception about CPR skills, confidence level in performing CPR and knowledge in performing CPR. Knowledge was assessed by a questionnaire. We found that 16 of 26 (61.5%) assessed themselves to have inadequate knowledge and 46.2% had no confidence in performing CPR. The mean score of the written test was 5.7 ± 1.8. Seven out of 26 (27.0%) HOs had incorrect hand placement position for CPR. Only 4 and 9 out of 26 HOs had their sternal paddle and cardiac apex paddle positions correctly placed respectively. In conclusion, knowledge, perception of skills and confidence levels of HOs on CPR are inadequate and need further assessment and improvement. Medical schools need to review their CPR curriculum in order to prepare HOs adequately to work in emergency situations.

Anxiety and depression among patients before and after Percutaneous Coronary Intervention (PCI) at National Heart Institute(NHI)

Percutaneous coronary intervention (PCI) is an invasive diagnostic investigation that may result in high level of anxiety and "fear of the unknown" among cardiac patients. An increment of anxiety among PCI patients will augment the level of stress and this extreme stress level will then aggravate depression. The objective of this study was to determine the incidence of anxiety and depression before and after PCI. This was a cross-sectional descriptive study. The Hospital Anxiety and Depression Scale (HADS) was used. It measured two elements, namely the anxiety and depression levels of patients before and after PCI.This study was conducted in the cardiology wards Anggerik and Dahlia, and Day Care of the National Heart Institute, from January to February 2006. A sample of 61 patients before and after PCI who fulfilled the inclusion criteria were recruited in this study. Of these, 40 and 38 patients before and after PCI respectively , had low anxiety levels; while 47 and 46 patients before and after PCI had low depression levels.Anxiety and depression levels before and after PCI were not significantly correlated to socio demographic status. However a significant correlation (p<0.05) was found between anxiety and depression levels before and after PCI. The low levels of anxiety and depression seen among patients before and after PCI at National Heart Institute could possibly due to the adequate facilities and health education program provided by the physician, nurses and cardiac technician.