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@#Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.
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@#Introduction: Malaysian Paediatricians suffer from psychological challenges and stresses, but unfortunately, their quality of work life (QWL) has yet to be studied. This study aims to explore the QWL score and its predictors among the qualified paediatricians of Universiti Sains Malaysia (USM). Methods: A cross-sectional study using a validated QWL questionnaire was performed from June to December 2022. The graduates of Master of Medicine in Paediatrics (USM) were invited to participate in the study, through an online built QWL questionnaire. Reminders were sent a few times to increase the response rate. The QWL was used due to a good internal consistency with Cronbach alpha of 0.95. Descriptive statistics were used to analyse the sociodemographic characteristics. The variables for QWL were determined using logistic regression analysis. Results: The study included the participation of 123 paediatricians. Majority of the participants were Malay (87.8%), Muslim (90%) and married (78%). Among all participants, 53.6% has good QWL score. Factors that associated with good QWL were married status (p= 0.02) and higher salary (p=0.012). Individuals whose are married and having higher income are 3.2 and 5.2 times respectively more likely to have good QWL. Conclusion: More than half of qualified paediatricians had good QWL and necessary steps should be strived at improving these factors for a better work-life balance.
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@#Introduction: The aim of the study is to determine the prevalence of burnout and correlation between burnout score and stressor domain score and to determine the association between sociodemographic and occupational related factors with overall burnout among nurses caring for children in Hospital Universiti Sains Malaysia (Hospital USM). Methods: This was a cross-sectional study using bilingual validated questionnaire; the General Stressor Questionnaire (GSQ) and Copenhagen Burnout Inventory (CBI) conducted among nurses providing medical service for children in Hospital USM particularly in wards and clinics. All 159 eligible nurses were recruited and 157 completed questionnaires were analysed. Pearson’s correlation analysis was applied to study the correlation while simple logistic regression and multiple logistic regressions were applied to study the association. Results: The prevalence of burnout among nurses caring for children in Hospital USM was 28.7% (95% CI = 21.6, 35.7) with the majority of them experienced personal burnout (49.7%, 95% CI = 41.9, 57.5). There was a significant moderate positive correlation between different stressor domain score with overall burnout score with p-value < 0.05. Work placement and bureaucratic constraints were identified as the main contributory factor leading to overall burnout. Conclusion: Burnout among nurses providing medical services for children in Hospital USM is of concern especially involving personal burnout. The main stressor related factors of burnout were work placement and bureaucratic constraints. Therefore, burnout among nurses providing care for children must be addressed in order to enhance their psychological well-being.
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@#Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.
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@#Introduction: Compliance with Hand hygiene (HH) has been considered as a simple and the most efficient strategy to reduce hospital-acquired infections (HAIs). Compliance with this practice is not often assessed in Nigeria and thus posed a significant risk to the quality of care and patient safety and especially in this era of the COVID-19 pandemic. The study aimed to assess neonatal nurses’ compliance to “my five moments for HH”. Method: A cross-sectional observational study was carried out in a Nigerian federal hospital, using an adapted version of a standardized observational WHO tool of ‘’my five moments of HH’’. A Chi-square test was employed to examine the relationship of HH compliance across units, shifts, and “my five moments for HH” opportunities. Results: The observer recorded 425 HH opportunities and the total HH compliance rate was (62.8%). There was no association between the units, working shifts, and nurses’ HH compliance. Compliance to HH was dependent on the five moments of HH (p < 0.000), better compliance was seen after body fluid exposure (100%), followed by after newborn contact (86.3%), and after contact with newborn surroundings (63.4%), while compliance before newborn contact (28.5%), and before an aseptic procedure (9.1%) were poor. Conclusion: The findings of this study showed a significant gap with the HH compliance among neonatal nurses, suggesting multiple opportunities for neonatal infections despite the current awareness of HH in the Covid-19 pandemic. Hence, there is a need to intensify infection control practices in Nigeria, especially on HH practice.
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@#Online learning is now becoming a teaching norm across disciplines and educational contexts. There is a need to measure the satisfaction level objectively and comprehensively to allow refinement of teaching and learning delivery methods. To date, there is no English validated scale to measure learners’ satisfaction when learning is conducted online. We aimed to translate and validate the E-Course Satisfaction Scale which is originally in Turkish into English among undergraduate medical students. We found that this 35-items with five-point Likert-type responses English version of the E-Course Satisfaction Scale is valid and reliable to measure students’ satisfaction on their e-learning experiences.
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@#Introduction: Paediatric Palliative care has been a relatively new specialty in Malaysia. It serves to cater hospital and community support for children with life-limiting illnesses (LLI). The aim of the study is to describe the clinical characteristic of Paediatric Palliative Care (PPC) cases in the North East of Peninsular Malaysia. Methods: Children with LLI were identified through 2 databases captured by the ‘Sayangku’ Homecare team and Paediatric Palliative Care (PPC) team. These databases include the details on clinical diagnosis, time of referral and outcome. Children included were those referred from November 2012 to March 2020 to PPC service. The number of new cases referred per annum (2019) was compared to the crude estimation of prevalence. Results: A total of 216 children were included. About half of the children with LLI (50.5%) were from group 4 and about a quarter from group 1 (27%) of the ACT/ RCPCH classification. Approximately one third of our cohort (31%) had died, majority from oncology causes. There were 116 neurology cases, 60 oncology cases and further 48 cases were the remaining cases in our databases. More than one third (37.5%) of the patients were in the age range of 11-18-year-old. The estimated cases under PPC was only 7.7% from the estimated annual prevalence of LLI. Conclusion: The current data showed that many of the LLI cases in our area have gone underreported. There is a need to disseminate information and awareness among the medical fraternity on the patient’s eligibility for the PPC service.
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The competency assessment of tomorrow's doctors plays a vital role to offer insight into their clinical abilities and overall achievement. This study explores difficult index, discrimination index, areas under ROC curve, sensitivity and specificity of assessment components employed in the pediatric examination in Universiti Sains Malaysia [USM]. A retrospective record review of medical undergraduates' examination performance was done. The target population were fourth-year medical students in 2012 [n = 210] and 2013 [n = 177] academic year that sat for the pediatric end posting examinations after completing a 6-week rotation. Each of the examinations comprised of MCQ and Long Case. The difficulty index of MCQ ranged from 0.67 to 0.79, which is considered as optimal level. The difficulty index for Long Case ranged from 0.89 to 0.91, which is considered as less optimal level. The MCQ demonstrated higher discrimination index [0.58-0.76] than the long case [0.20-0.23], suggesting the MCQ was better able to discriminate poor and good students than the long case. MCQ has more evidence to support its discriminant validity and optimal difficulty level than the long case for both cohorts of medical students. The MCQ has good psychometric credentials which may results of the broad sampling of knowledge over short duration of time, while the long case seems to have poor psychometric credentials which may results of the assessment subjectivity