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Chronic wounds are associated with significant clinical, economic and quality‐of‐life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5‐week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter‐rater and intra‐rater reliability between clinical and TA‐based measurements were analysed using intra‐class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5‐week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter‐rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799‐0.919, P < 0.001). Separate measurements of intra‐rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967‐0.985 and range 0.977‐0.984 respectively, P < 0.001). Inter‐rater reliability between TA used on the iOS and Android systems was also excellent (0.987‐0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity. [ABSTRACT FROM AUTHOR]

To investigate factors associated with outcome of second twin during labour. The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation. Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15–29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth. The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. Background: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi‐ethnic country. Design: A cross‐sectional study design. Methods: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE‐Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). Results: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self‐driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face‐to‐face, centre‐based cardiac rehabilitation approach. Conclusion: Several barriers were associated with non‐participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home‐based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. Relevance to clinical practice: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation. [ABSTRACT FROM AUTHOR]

Background: Self-management support has been recognized as one of the most essential elements of the Chronic Care Model (CCM). Inspired by the CCM, the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed to aid and sustain self-management among patients with metabolic syndrome (MetS) in primary care to prevent cardiovascular complications. However, the usability of this booklet among these patients is not known. Therefore, this study aimed to evaluate the usability of this self-management booklet and identify the factors associated with its usability among patients with MetS in primary care. Methods: This cross-sectional study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. The usability score was measured using a previously translated and validated EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) with a score of > 68 indicating good usability. Multiple logistic regressions determined the factors associated with its usability. Results: A total of 391 patients participated in this study. More than half (61.4%) had a good usability score of > 68, with a mean (± SD) usability score of 72.8 (± 16.1). Participants with high education levels [secondary education (AOR 2.46, 95% CI 1.04, 5.83) and tertiary education (AOR 2.49, 95% CI 1.04, 5.96)], those who used the booklet at home weekly (AOR 2.94, 95% CI 1.63, 5.33) or daily (AOR 2.73, 95% CI 1.09, 6.85), and those who had social support to use the booklet (AOR 1.64, 95% CI 1.02, 2.64) were significantly associated with good usability of the booklet. Conclusions: The usability of the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was good among patients with MetS in this primary care clinic, which supports its widespread use as a patient empowerment tool. The findings of this study also suggest that it is vital to encourage daily or weekly use of this booklet at home, with the support of family members. The focus should also be given to those with lower education to improve the usability of this booklet for this group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Apert, Crouzon, and Pfeiffer syndromes are common genetic syndromes related to syndromic craniosynostosis (SC), whereby it is a congenital defect that occurs when the cranial growth is distorted. Identifying cranial angles associated with these 3 syndromes may assist the surgical team to focus on a specific cranial part during the intervention planning, thus optimizing surgical outcomes and reducing potential morbidity. Objective: The aim of this study is to identify the cranial angles, which are associated with Apert, Crouzon, and Pfeiffer syndromes. Methods: The cranial computed tomography scan images of 17 patients with SC and 22 control groups aged 0 to 12 years who were treated in the University Malaya Medical Centre were obtained, while 12 angular measurements were attained using the Mimics software. The angular data were then divided into 2 groups (patients aged 0 to 24 months and >24 months). This work proposes a 95% confidence interval (CI) for angular mean to detect the abnormality in patient's cranial growth for the SC syndromes. Results: The 95% CI of angular mean for the control group was calculated and used as an indicator to confirm the abnormality in patient's cranial growth that is associated with the 3 syndromes. The results showed that there are different cranial angles associated with these 3 syndromes. Conclusions: All cranial angles of the patients with these syndromes lie outside the 95% CI of angular mean of control group, indicating the reliability of the proposed CI in the identification of abnormality in the patient's cranial growth. [ABSTRACT FROM AUTHOR]

The present study aimed to validate the Malay Happiness at Workplace (M-HAW) index questionnaire. A cross-sectional survey study with a convenience sampling method was carried out at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The forward-backward approach was used to translate the original 11 items of the M-HAW questionnaires, which were then distributed to respondents. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were utilised to assess the questionnaires' validity and reliability. A total of 501 healthy individuals were included in the study, with 72% female respondents and a mean age of 37.63 + 7.60. The questionnaire was generally well-received by participants, and reliability standards were met (Cronbach's α = 0.95). The EFA shows two distinct factors, namely individual and environmental factors. The CFA shows that the model was fit (RMSEA= 0.076, CFI= 0.978, x2/df= 3.31). The M-HAW demonstrated its validity as a good tool for determining happiness in the workplace. The M-HAW questionnaire can be used as a screening tool to measure happiness, and should be able to help an organisation provide suitable interventions to improve employee happiness. INSET: 1. [ABSTRACT FROM AUTHOR]

Postoperative sore throat (POST) is a common complication with incidence of 30-90% when intubation was done using conventional Macintosh laryngoscope. Although POST is usually self-limiting and with no long-term morbidity, it can lead to patient's discomfort and dissatisfaction in the postoperative period. The objective of this study was to compare the incidence of POST following intubation using Macintosh laryngoscope and C-MAC® videolaryngoscope (VL) at various time intervals post anaesthesia. This prospective randomised controlled study comprised of 128 patients with American Society of Anesthesiologists (ASA) I and II status who underwent elective surgery under general anaesthesia in Universiti Kebangsaan Malaysia Medical Centre. All recruited patients have normal airway and divided randomly into Group 1 and Group 2 that used Macintosh laryngoscope and C-MAC® VL during intubation, respectively. Patients were evaluated for sore throat, hoarseness of voice, dysphagia and coughing at recovery, 6 hours, 12 hours and 24 hours after intubation. Severity of POST was assessed using numerical rating scale (NRS). Incidence of POST was found to be higher in the Macintosh laryngoscope group (61.9%) compared to C-MAC® VL group (47.9%) although the difference was not statistically significant (p=0.107). Median pain score was used to assess the severity of POST, showing low and comparable in both groups at all time intervals. There were also no significant differences seen in hoarseness of voice, coughing and dysphagia for both groups during postoperation. Incidence of POST following intubation using C-MAC® VL and conventional Macintosh laryngoscope were comparable. This study revealed that severity of POST was generally low in both groups. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated the role of laser ablation of anal fistulae in the European setting. However, long-term follow-up results following laser fistula ablations are not widely investigated and no study was performed in the Asia-Pacific, a region with a distinctive prevalence of tuberculosis. The primary objective of this study is to report a single-centre experience with laser ablation of anal fistulae in Malaysia over a period of 6 years.Method: This was a retrospective observational study assessing the outcomes following 70 laser ablations of anal fistulae from February 2014 till December 2019. All cases were assessed using endoanal ultrasound. The laser ablation procedures were performed using laser systems and fibres from Endoteq Medizinische Laser GmBH, Germany, and Biolitec AG, Jena, Germany. Laser fibres were introduced into the fistula tract and laser energy was emitted radially in continuous mode when activated during the procedure. Pre-defined post-procedural outcomes (primary healing, healing failure or recurrence) were recorded as either present or absent during subsequent follow-up appointments and the data was analysed.Results: Over a median follow-up period of 10 months, primary healing was reported following 42 procedures (60.0%). Healing failure was reported following 28 procedures (40.0%) whilst recurrence was seen after 16 procedures (22.86%). No new cases of incontinence were reported following the procedure.Conclusion: The reported primary healing rate following laser ablation of anal fistulae in this study appears consistent with existing literature published by other international centres. The most apparent clinical advantage of this procedure is sphincter-function preservation. However, the primary healing rate after isolated laser fistula ablation is still suboptimal. Judicious patient selection and application in anal fistulae with suitable characteristics could potentially improve the post-procedural outcomes. [ABSTRACT FROM AUTHOR]

To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration. [ABSTRACT FROM AUTHOR]

Introduction. Triglycerides are lipids composed of fatty acids that provide energy to the cell. These compounds are delivered to the body's cells via lipoproteins found in the bloodstream. Increased blood triglyceride levels have been associated with high-fat or high-carbohydrate diets. Generally, increased triglyceride levels occur in conjunction with other symptoms that are difficult to notice and recognize. Objectives. The study's goal was to develop and predict the model that could be used to explain the relationship between triglycerides and waist circumference, high-density lipoprotein (HDL), and hypertension status by determining the relationship between triglycerides and waist circumference, HDL, and hypertension status. This model was developed using qualitative predictor variables and incorporated data bootstrapping multilayer perceptron neural networks and fuzzy linear regression. Materials and procedures. This was a public health study that combined retrospective data analysis with methodology development. The medical records of patients who attended outpatient clinics at Hospital Universiti Sains Malaysia (USM) were collected and analyzed. This was to provide a more extensive illustration of the methods developed. Screening and selection of patient data were necessary following the inclusion and exclusion criteria. The patient's medical record was used to obtain triglycerides, high-density lipoprotein (HDL), waist circumference, and hypertension status. Due to the critical nature of the variable, it was chosen to aid the clinical expert. The R-Studio software was used to develop the associated syntax for the hybrid model, which would define the association between the examined variables. The purpose of this study is to create a technique for the clinical trial design that utilizes bootstrapping, Qualitative Predictor Variables (QPV), Multiple Linear Regression (MLR), Artificial Neural Networks (ANNs), and Fuzzy Regression (FR). All analyses were performed using the newly introduced R syntax. The research developed a fuzzy linear model that increased modelling performance by incorporating clinically significant factors and validated variables via Multilayer Perceptron (MLP). Conclusion. The proposed technique for modelling and prediction appeared to be the ideal combination of bootstrap, Multilayer Feed Forward (MLFF) neural network, and fuzzy linear regression. The created syntax is currently being evaluated and validated clinically. For modelling and prediction, the proposed technique looked to be the best, as it incorporated bootstrap, MLFF neural network, and fuzzy linear regression. The established syntax is now being utilized in the clinic to evaluate and validate the outcome. In terms of variable selection, modelling, and model validation, this strategy was superior to earlier approaches for fuzzy regression modelling. [ABSTRACT FROM AUTHOR]

Background: Healthcare‐associated infection (HAI) is one of the major threats to patients' safety besides being among the principal causes of patient morbidity and mortality. Catheter‐associated urinary tract infection (CAUTI) is reported to be the most common HAI worldwide. CAUTI can be prevented with appropriate practice and care by healthcare personnel, especially nurses, who play the main role in urinary catheter care. Nurses' knowledge and attitude are considered to be important factors that influence their practice. Objectives: To assess nurses' level of knowledge, attitude and perceived practice regarding CAUTI and its preventive measures. Methods: A cross‐sectional design was adopted, and a self‐administered questionnaire was used to collect data. Nurses from the medical and surgical inpatient wards of a tertiary teaching hospital in Malaysia were recruited in two stages using the stratified and simple random sampling methods. A total of 301 nurses participated. Descriptive analysis, an independent t test, ANOVA and hierarchical multiple regression were employed to analyse the data using SPSS software version 25. In addition, a STROBE checklist was used to report the results of this study. Results: Nurses were found to have good knowledge, a positive attitude and good perceived practice regarding CAUTI prevention. Nurses aged above 30 and who had more than ten years of experience reported higher knowledge levels. Knowledge was found to be positively correlated with attitude and perceived practice; however, attitude explained a higher variance in perceived practice of CAUTI prevention compared with knowledge. Conclusion: Attitude was found to have a higher significant influence on perceived practice in this study. Educators need to emphasise the inculcation of a positive attitude among nurses rather than just knowledge for CAUTI prevention. Since this study assessed perceived practice, examining nurses' actual practice and its impact on patient outcomes is recommended in future studies. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors' service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction. [ABSTRACT FROM AUTHOR]

Background: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia. Aims and objectives: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables. Design This was a cross‐sectional survey. Methods: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ2 and hierarchical logistic regression tests were used to analyse the data. Results: A total of 229 CCNs completed the self‐administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave. Conclusion: This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases. Relevance to clinical practice: Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses. [ABSTRACT FROM AUTHOR]

Aim: To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. Background: Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. Methods: A cross‐sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. Results: The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00–5.00), which differed across 24 nursing care elements. Basic nursing care and communication‐related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p <.001). No significant association was found between missed nursing care and nurses' intention to leave (p >.05). Conclusion: The occurrence of missed nursing care was noted to be low. Implications for Nursing Management: Practical strategies such as an acuity‐based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care. [ABSTRACT FROM AUTHOR]

Background: Nurses play a key role in the proper management of endotracheal tube (ETT) cuff pressure, which is important for patients' safety, so it is vital to improve nurses' knowledge on safe cuff management practices. Aims and objectives: This study aimed to evaluate the effectiveness of an educational intervention related to ETT cuff pressure management on improving and retaining critical care nurses' knowledge. Design: A single group pre‐post interventional study was conducted involving 112 registered nurses (RNs) from a 24‐bed adult general intensive care unit at a teaching hospital in Malaysia. Methods: The educational intervention included a theoretical session on endotracheal cuff pressure management and demonstration plus hands‐on practice with the conventional cuff pressure monitoring method. Nurses' knowledge was measured using a self‐administered questionnaire pre‐ and post‐intervention. Data were analysed using repeated measure analysis of variance and bivariate analysis. Results: In this study, 92% of the total number of RNs in the unit participated. A significant difference in mean knowledge score was noted between the pre‐ (mean = 8.13; SD = 1.53) and post‐intervention phases (3 months [mean = 8.97; SD = 1.57) and 9 months post‐intervention [mean = 10.34; SD = 1.08), P <.001), indicating significant knowledge acquisition and retention between the phases. Knowledge gained between the pre‐ and 9 months post‐intervention phases significantly differed according to nurses' educational level. Conclusions: This study supports existing evidence that ongoing educational interventions are essential to improve nurses' knowledge. However, further exploration is suggested to assess how well this knowledge is translated into clinical practice. Relevance to clinical practice: Regular educational programmes with current updates would enhance nurses' knowledge through proper practice and clinical decision‐making skills; this, in turn, would help to standardize cuff management practices. [ABSTRACT FROM AUTHOR]