9 1 2009 Volume • No • M e d i c a l P r a c t i c e Hospital Ipoh 8 Editorial 9 Abstracts of Health Systems Research in Perak 2007-2009 (Some Community Trials are included in this section) 17 Abstracts of Clinical Research in Perak 2007-2009 79 Abstracts of Quality Assurance Studies in Perak 2007-2009 109 Abstracts of Epidemiological Research in Perak 2007-2009 114 Abstracts of Case Series in Perak 2007-2009 127 Instruction To Authors Editorial 8 National Medical Research Register Lina Hashim, Amar-Singh HSS Abstracts of Health System Research in Perak 2007-2009 9 Improving Knowledge On Type 2 Diabetic Patients On Oral Hypoglycaemic Agents Mohd-Rohaizad Z, Umi-Hani MA, Mohd-Fadhil S, Liliwati I, Amar-Singh HSS, Sondi Sararaks, Ranjit K, Asmah ZA, Ruzita M, Sabab H 10 Health Seeking Behavior Towards Communicable Diseases Among Foreign Workers In Industrial Sector And Agriculture Sector In Selected Districts In Perak Koh Kean Yau, Ong Kuo Ghee, Noor Asmah Ahmad Shah Azizi, Wan Asmuni Wan Mohd. Saman, Asmah Zainal Abidin, Marina Kamaruddin, Amar-Singh HSS, Sondi Sararaks, Ranjit Kaur 11 Improving Asthma Care In Ministry of Health Primary Care Clinics Shahnul Kamal S, Siti Khadijah H, Teng KS, Normah MZ, Zainab N, Paranthaman V, Amar-Singh HSS, Sondi Sararaks, Ranjit K, Asmah ZA 12 Vaccine Storage In Private Practice: A Community Trial In Malaysia Gopal-Krishnan Sheila, Sondi Sararaks, Amar-Singh HSS, Lidwina EA, Yusof MI, Ranjit KPS, Azman AB, Maimunah AH, Faridah AB, Kok JL, Noorizah M, Wong SL 13 Improving Blood Pressure Controls In Primary Care Settings Baharin Zarina, Ahmad Fauziah, Khalib Syah-Izaini, Kamaruddin Marina, Amar-Singh HSS, Sondi Sararaks, Kaur Ranjit, Ahmad Morni-Fauziah, Zainal- Abidin Asmah 14 The Involvement Of Lay Educators In The Diabetic Control Of Type 2 Diabetic Patients Sebrina HC Su, Isa Nurhayati, Yusof Zawiyah, Parasuraman Paramaisvary, Amar-Singh HSS, Sondi Sararaks, Kaur Ranjit, Hussin Narwani, Zainal-Abidin Asmah, Jamalludin Mazilah, Abdul-Rashid Khairul Amir 15 Effective Implementation Of A Structured Psycho-education Programme Among Caregivers Of Patients With Schizophrenia In The Community Paranthaman V, Kaur Satnam, Jean-Li Lim, Amar-Singh HSS, Sondi Sararaks, Mat-Nasir Nafizah, Kaur Ranjit, Zainal-Abidin Asmah 16 Home Safety Practices For Prevention Of Poisoning In Young Children Shoba P, Lina H, Affendi Y, Vishanthri K, Puah HM, Amar-Singh HSS , Sondi Sararaks, Ranjit K, Asmah ZA Abstracts of Clinical Research in Perak 2007-2009 17 Oral Proton Pump Inhibitors – Medication Use Evaluation Eng NL, Chan LY, Lim PN, Thong KS, Lau KK, Pan SC Shanthi Palaniappan A Publication of the Postgraduate Medical Education Society, Hospital RPB Ipoh ISSN 1394-8474 Medical Practice Hospital Ipoh 18 Study On Overstocking Of Medication And Its Cost Savings By Intervention In Hospital RPB Ipoh Chong Li Yun, Khaw Yee Thai, Tan Jye Yee 19 Study On Preterm Normal Sodium Standard Parenteral Nutrition Regime In Hospital RPB Ipoh: Effect On Costing Akmalyatun Kamal Kamaruddin, Ku Nurhasni Ku Abd Rahim, Ros Sakinah Kamaludin 20 A 5-Year Retrospective Study On Outcome Of Patients With Acne Vulgaris Treated With Oral Isotretinoin In Hospital RPB Ipoh Tang JJ, Chan LC, Heng A 21 Powered Endoscopic Dacryocystorhinostomy With Mucosal Flaps Without Stenting Harvinder S, Rosalind S, Philip R, Mallina S, Gurdeep S 22 Management Of Sinonasal Inverted Papillomas: Endoscopic Medial Maxillectomy Harvinder S, Rosalind S, Mallina S, Gurdeep S 23 Endoscopic Cauterisation Of The Sphenopalatine Artery In Persistent Epistaxis Harvinder S, Rosalind S, Gurdeep S 24 The Effectiveness Of Preventive Measures Taken To Prevent Inpatients From Accidentally Falling In Seri Manjung Hospital Noor Hayati Kamaruddin, Hashimah Jamaluddin, Catherine Choong, Faridah Ahmad 25 Relationship Between Job Stress, Job Satisfaction And Propensity To Leave Among The Paramedics Abdul Aziz Mohd Nor 26 Low Back Pain And Associated Factors Among Nurses In Kuala Kangsar Hospital Kogilavani Krishnan 27 A Study To Assess The Awareness And Knowledge Of Computer Usage Among Nurses In Teluk Intan Hospital Asiah Abd. Majid, Hari Mohan 28 Type II Diabetic Patients’ Opinions On Insulin Therapy And Knowledge Of Diabetes Annie Leong, Tan Hock Lang 29 Usage Of Hospital-Made Eye Pads And Its Acceptance By Mothers Aishah Tajuddin, Roziwati Ramli, Noraini Sharif 30 Intrathecal Morphine For Post-Lower Segment Caesarian Section Pain Management Thelagavathy G, Awisul G 31 Mis-Triage In Trauma And Emergency Department, Hospital RPB Ipoh, Perak Adi Osman, Mohammad Najib Adnan, Azman Omar, Mat Isa Shaari 32 Mothers’ Feelings At The Time Of Their Baby’s Admission To Special Care Nursery And 24 To 48 Hours Later Noraini, Roziwati, Aishah 33 Assessing The Turn-Around-Time Of The Integrated Pre-Analytical And Analytical Modular System Ho Kam Leng, Sabab Hashim, Govindasamy, Mat Aroff, Redzuan 34 Randomised Controlled Trial On Scapular Protraction Exercise Gives Immediate Pain Relief And Increase Range Of Motion In A Painful Hemiplegic Shoulder Nurul Liyana Teong 35 Prescribing Patterns At Outpatient Pharmacy Department, Teluk Intan Hospital Norfauziah Hashim, Wong Ah Khuan 36 Quality Of Life In Patients With Knee Osteoarthritis Attending Physiotherapy Treatment Chen Pei Yean 37 The Occurrence Of Haemolysed Blood Specimens In Seri Manjung Hospital Fadzle Hashim, Hayati Alwani Yahya, Udaya Shankar, Noor Hayati Kamaruddin, Faridah Hanim Sulaiman 38 Mothers’ Perception On The Importance Of Antenatal Ultrasound Ghani HP, Japaraj RP, Mukudan K 39 The Impact Of Centralisation And Networking Of Service In Perak – The Hospital RPB Ipoh Experience Chong LC, Shiamini K, Ahmad Toha, Norain Karim 40 A Preliminary Study On Urine Culture Samples Received In The Microbiology Laboratory, Hospital RPB Ipoh Che Mahadi CK, Mohd Shahrizal MD, Wan Nor Amilah WAW 41 Pre-Analytical Venous Blood Sampling In Transfusion Practices Demand Improvement Valsala Kumari KSN, Zaleha AH, Ida, Kalaichelvi M, Norain K, Zuraidah M, Azura S 42 Impact Of Occupational Therapy On Carpal Tunnel Syndrome Aznani Ismail 2 Vol 9 • No 1 • 2009 Medical Practice Hospital Ipoh 43 Work-Related Musculoskeletal Disorders: A Small-Scale Survey Of Physiotherapists In Perak Teng Ai Leng 44 Preventing High Risk Situations Of Needle Stick Injury Among Health Care Professionals Lim Kah Bee, Nor Lelawati MK, Noor Hasaniyah H, Aina Juana MA, Cham Weng Tarng, Amar-Singh HSS 45 Care Of The Chronically III Dying Child And Their Parents By Health Care Professionals Norsafiza Saubari, Zarina Mohd Napiah, Nurshuhaida Idris, Lee Sok Yee, Amar-Singh HSS 46 Effects Of Rheumatoid Arthritis Disease On Female Patient’s Performance In Cooking Activity – A Patient’s Experience Kamaliyah Ramli 47 Specimen Rejection In Hospital Laboratory – Causes And Implications Kadir Ithnin, Bainon Daud, Sabariah Mat Nor, Norain Karim 48 Improving The Management Of Patients With Intravenous Therapy In Gerik Hospital Chiang AY, Shariyah MR, Norazlina M, Norizan MN, Zainon O, Rozana M, Mazziana M, Maznah AH, Murni M, Norhazila MA 49 Contributing Factors Towards The High Turn Up Of Non-Fasting Patients For Contrasted Computer Tomography Examination Noor Aziah Mohd Daud, Sivaneswaran, Sabrinie Azira, Nurul Mazni 50 Response To Short Wave Diarthermy Treatment In Supraspinatus Tendonitis Rajasavary LV 51 Depression Among Diabetic Patients In Outpatient Clinic In Sik Hospital Ng Teng Khai 52 A Pilot Study Evaluating Patients’ Satisfaction And Quality Of Life Outcome Of A Pharmacist-Initiated Methadone Programme In A Malaysian Public Health Clinic Chiew Geok Ping, Asrul Akmal Shafie, Mohamed Azmi Ahmad Hassali, Ahmed Awaisu, Cheah Wee Kooi 53 Prevalence Of Osteoporosis And Predictors Of Bone Mineral Density In Chronic Kidney Diseases of Stage 2 And 3 Among Type 2 Diabetics Cheah Wee Kooi, Indralingam YT Vathilingam, Mohd Haizad Yusof 54 Evaluation Of Serum Concentrations And Toxicities In Cancer Patients Receiving High Dose Methotrexate In Hospital RPB Ipoh Doris GV, Rahman AFA, Padmini M, Tharam S 55 Practice Of Sedation Of Neonates Before Intubation In The Neonatal Intensive Care Units Zarena Ismail, Nurul Huda Ishahar, Siti Suhaila Yusof, Amar-Singh HSS, Tan Saw Cheang 56 Chikungunya Co-infection Increases The Severity Of Dengue Infection Lee LY, Tieh SC, Teoh MY, Shubashinni S, Roshila, Leong SW, Laang ST, Wan Zaharatul, Thanusia 57 Practice Of Rapid Sequence Intubation In The Emergency And Trauma Department, Hospital RPB Ipoh Ruth Sabrina MS, Adi Osman, Abdul Kursi AL 58 Perception Of Nurses Towards The Implementation Of Nursing Care Plan With Nursing Process Approach As A Nursing Documentation In Hospital Seri Manjung Au Yit Moy 59 Pharmacoepidemiologic And Cost Evaluation Of Type 2 Diabetes Management At Taiping Hospital Kamariah Shamsinar Kamarul Baharin, Alice Chuah Lay Hong, Nurhani Azmi, Mohamed Azmi Ahmad Hassali, Letchuman GR 60 Assessing The Impact A Structured Health Education Can Have On Improving Parents/Guardians Knowledge And Awareness Regarding Influenza A Rabin Jason Vikrama, Mah Sin Yeat, Phang Yuk Jean, Chan Sow Keng 61 A Study Of Medically Compromised Children With Severe Early Childhood Caries Thevadass KP, Chitra Devi S, Aida Shafiza 62 Painful Symptoms In Patients With Depression Esther Ebenezer, Siti Aisah Mokhtar 63 Effect Of Depression On Quality Of Life (QoL) Among Patients With Diabetes Mellitus Esther Ebenezer, Letchuman GR 64 Impact Of A Multidisciplinary Intervention In A Cardiac Rehabilitation Programme On Post-Myocardial Infarction Patients At Teluk Intan Hospital Lai Yin Yin, Lee Lay Chin, Bee Siew Lee, Maisarah, Abdul Haniff Mohd Yahaya, Doris George Visuvasam, Gan Pei Sung Vol 9 • No 1 • 2009 3 Medical Practice Hospital Ipoh 65 The Use Of Traditional And Complementary Medicine Among Diabetes Patients At Teluk Intan Hospital Nur Azmani Idris Mohamed, Vincent Oh Chen Wei, Abdul Haniff Mohd Yahaya, Doris George Visuvasam, Zahariah Zainul Abideen 66 Lumbar Puncture In Children With Febrile Fits Ravi Kumar R, Bazlin Ramly, Amar-Singh HSS 67 Evaluation Of A Trend Of Management Practice And Outcome Of Breech Delivery At Tertiary Hospitals After An Emerging Evidence Of Term Breech Is Best Delivered By Caesarean Section: A Multi-Centre Study Sharifah HJ, Mohd Azhar MN, Lau PH, Japaraj RP, Gorgon CVH, Carol LKK, Mukudan K 68 Interventional Trial Comparing Perineal Cool Pads And A Standard Oral Analgesic In The Treatment Of Perineal Pain In The First Day After Vaginal Delivery Rahimah R, Ramesh V, Liza LP, Japaraj RP, Mukudan K 69 Outcomes Of Ovarian Drilling Among Women With Polycystic Ovarian Syndrome Jayabalan V, Ramesh V, Yew KM, Mukudan K 70 Prevalence Of Anal Incontinence And Quality Of Life Of Patients With Urinary Incontinence And Pelvic Organ Prolapse In Hospital RPB Ipoh Karen JK, A Naidu, Mukudan K, Nik Hazlina NH, Nik Zaki NM 71 Sonographic Detection Of Placenta Accreta In The Second And Third Trimesters Of Pregnancy Revinderjit K, Japaraj RP, Ramesh V, Roha AZ, Chew SH, Mukudan K 72 Thrombotic Thrombocytopaenia Purpura In Pregnancy: A Diagnostic Dilemma Ravinderjit K, Japaraj RP, Ramesh V, Roha AZ, Chew SH, Mukudan K 73 A Local Experience On The Use Of Cyclosporine For The Treatment Of Psoriasis Tang MM, Chan LC, Heng A 74 Improving The Clinical Response Of Atopic Eczema Patients By Improving Their Understanding On The Proper Application Of Topical Treatment Tang MM, Chan LC, Heng A 75 Removal Of Foreign Bodies Under General Anaesthesia – A Review Of Rigid Endoscopy For Foreign Bodies Of The Hypopharynx And Oesophagus Revadi G, Philip R, Gurdeep S 76 Trends Of DMARDs Prescribed In Rheumatoid Arthritic Patients In Malaysia – A Single Centre Study Wahinuddin Sulaiman, Ashraful Anuar Toib, Anwar Samhari Mat Arshad 77 Maternal Knowledge And Ability To Perform Cardiopulmonary Resuscitation On Babies Prior To Discharge At Hospital RPB Ipoh Rajeswari Rajendran, Noraine Ali, Zuliaini Deraman, Norbaiyzura Hussain, Norliana Edros, Noor Hayati Mohd Sharif, Foo Sook Lee, Amar-Singh HSS 78 Impact Of Pharmacist-Conducted Counselling Sessions On Patients At Warfarin Clinic, Teluk Intan Hospital Vivian Chiam ZW, Chew LS, Abdul Haniff MY Abstracts of Quality Assurance Studies in Perak 2007-2009 79 High Incidence Of Hypotension After Spinal Anaesthesia In Lower Segment Caesarian Section Patients In Taiping Hospital Azaharim O, Awisul Islah G, Narwani H, Jamal A, As Niza A 80 High Incidence Of Peri-operative Cold And Shivering Among Patients Undergoing Lower Segment Caesarean Section In Taiping Hospital Awisul Islah G, Santini S, Yip KF, Norlida AB, Musrifful Hafiz H, Nora A 81 Improving Antibiotic Prescription In Dental Clinics Arlene KBH, Ferdinand JK, Lim CL, Siew L 82 Improving Management Of Gestational Diabetics At All Clinics In The District Of Larut, Matang & Selama Malliga S, Rozianita M, Noriza K, Junaidah AB, Hamisah MH, Rosidah W, Haslinda D, Suhaila AK, Zaleha B, Dalilah I, Roslina I, Azura A, Pusphalatha, Sumathi 83 Improving Recovery Time Of Amblyopic Patients Mai Rafa’ah MA 84 Improving The Number Of Premature Babies Not Tolerating Feeding In NICU, Hospital Teluk Intan Nizam Malik BM, Hasnah H, Ahmad Basri MT 85 Inadequate Pain Relief During Venepuncture In All Healthy Term Neonates In the Special Care Nursery, Taiping Hospital Kavitha Rethanavelu 4 Vol 9 • No 1 • 2009 Medical Practice Hospital Ipoh 86 Reducing Incidence Of Wrong Diabetic Diet Served To Patients In Third Class Ward, Taiping Hospital Balqis S, Wong LS, Junaidah A, Rozita MT, Mohd Nizam MY 87 Reducing The Cancellation Rate Of Elective Daycare Cataract Surgery In The Department Of Ophthalmology, Hospital RPB Ipoh Ong LB, Ch’ng TW, Mohd Tarmizi I, Syarifah Faiza SMD, Chew SS 88 Reducing The Rate Of Clean Wound Infection (Post-Toilet & Suture) At The Accident And Emergency Department, Batu Gajah Hospital Lee OW, Mohd Azizan, Aishah I, Norhayati L, Minah O 89 Reducing The Rate Of Near Misses In Blood Transfusions In Hospital RPB Ipoh Kalaichelvi AV Muthiah, Zuraidah Mokhtar, Azura Sadri, Valsala Kumari KS Nayor, Zaleha Abdul Hamid 90 Reducing The Routine Use Of Episiotomy In The Labour Room, Hospital RPB Ipoh Zeity AMK, Rahimah AR, Subalakshimi M, Rozita Y, Ranjit K 91 Reducing Wound Infection Rate For Diagnostic Skin Biopsy In The Dermatology Clinic, Hospital RPB Ipoh Tang Jyn Jong, Kong Siew Hong, Khairul Nizam 92 Lifespan Of Peripheral Intravenous Lines: A Form Of Quality In Patient Care S Nalini, Wong WY, Khadijah CD, Amar-Singh HSS 93 Improving Compliance Of Home Exercise For Osteoarthritis Knee Patients In Physiotherapy Outpatient Department, Taiping Hospital Hatiah Deris 94 Improving The Diagnostic Value Of Computed Tomography Scans Of The Cervical Spine In Acute Trauma Cases In The Department Of Radiology, Hospital RPB Ipoh Nazrila Hairiana N, Vimala K, Manimegalai V, Suhaila S, Ida Mashani AT 95 Increasing The Number Of Claimed Medications On To-Come-Again Date In “Farmasi Sahabat Anda” Patients Nazedah I, Wong YP, Ooi AF, Yong SM, Beh WY, Lee ZS, Ng WN, Katijah SAK, Nurul Syuhadah H, Nor Riha I, Hashim MY 96 Increasing The Rate Of Positive Microorganism Isolates In The Blood Cultures In The Medical Wards Lee LY, Tieh SC, Mohammad Zakuan, Eow YN, Razliza Razali, Saudi Baharom, Siti Azlina Mohd Yusof, Hamidah Abdul Kadir, Tan Peik Pei 97 Reducing Delays In Administering First Dose Of Intravenous Antibiotic To Patients In the Intensive Care Unit, Taiping Hospital As Niza AS, Awisul Islah G, Ng CB, Farrah Wahida A, Nurazrina Y, Wang PH 98 Towards Improving The Rate Of Contraceptive Usage By Postnatal Mothers In Perak Tengah District Chang ML, Elangovan S, Zarina B, Roziana AW, Sofiah MS, Azuwan AR 99 Reduction Of Inappropriate Antibiotic Usage In Acute Exarcebation Of Chronic Obstructive Airway Disease Patients Cheah WK, Eow LY, Erica YH, Rasidah AM 100 Kegagalan Pesakit Psikiatri Hadiri Klinik Susulan Hairullida S, Jaharudin S, Talib MA, Rohani MN, Normah Y, Maziani L, Halim Y, Zabedah AH, Khairiah Z, S Anisah SM 101 Kelewatan Menerima Keputusan Makmal Bagi Pesakit Yang Dirawat Di Jabatan Pesakit Luar, Hospital Selama Anusha K, Norliza K, Che Noor Aini I, Suriani I, Ruzana R, Rosliza M, Salbiah 102 Mempercepatkan Pesakit Menerima Hasil Keputusan Ujian “Blood Urea And Serum Electrolyte/ Creatinine” Di Unit Kecemasan, Hospital Slim River Nordin, Johari, Shahrul, Nurul Ain, Rose Nani 103 Mempercepatkan Proses Menghantar Pesakit Dari Hospital Gerik Ke Hospital Berpakar Erma Rosnida R, Rosilawati AH, Khairul Anuar MN, Endra K, Rozana M, Ainon S, Selmah M 104 Mengurangkan Masa Menunggu Di Unit Kecemasan Hospital Kampar Selepas Waktu Pejabat Hairul Azmi M, Azizah H, Masniewati M, Mariani A, Rubitah B, Mohd Amir Shah M 105 Meningkatkan Amalan Perancang Keluarga Di Kalangan Ibu Berisiko Di Klinik Kesihatan Plang Norasmah H, Hanita D, Nora AK, Irne JB, Asmahan Y 106 Meningkatkan Kadar Pesakit Yang Menepati Temujanji Di Klinik Pakar Bedah Mulut, Hospital RPB, Ipoh Vimahl D, Zahila MS, Netty N, Nor QA 107 Penambahbaikan Pengurusan Keputusan Biokimia Semasa Rawatan Susulan Di Klinik Kesihatan Pulau Pangkor Ling HM, Yeoh SF, Mashitah A, Sarahanna, Sujider S, Salbiah M, Razita H, Habsah AB Vol 9 • No 1 • 2009 5 Medical Practice Hospital Ipoh 108 Pengurangan Kos Pembaziran Ubat-Ubatan Di Wad-Wad Hospital Bahagia Ulu Kinta Yang Mengamalkan Sistem Pembekalan Konvensional Zulfa Z, Shamini R, Tan CE, Roslily K, Sharil MD, Basid A, Mohd Zaki H Abstracts of Epidemiological Research in Perak 2007-2009 109 Genetic And Environmental Effects On Age Of Menarche And Its Relation With Reproductive Health Shayesteh Jahanfar, Munn-Sann Lye, Ishtrinayagy S Krishnarajah 110 Awareness Of The United Nations Convention On The Rights Of The Child Among Doctors Working With Children In Malaysia Saw-Sian Chin, Amar-Singh HSS 111 Effectiveness Of A Structured Exercise In Improving Health Parameters In Pre-Diabetics Among High Risk Population In Kinta District Noridah Othman, Fauziah Abdul Karim, Suraya Amir Husin, Gui Shir Ley, Nalini Krishnasamy, Azizee Mohd Radzuan 112 Intestinal Parasitic Infections In Orang Asli (Aborigines) Schoolchildren In Bota District, Perak Amritpal Singh S, Ding KS, Sanjeevan R, Sinniah B, Elangovan S 113 Factors Affecting Drawing Ability In Children Aged 4-6 Living In The Rural And Urban By Socio- Demography Aspects Puganiswary Puvipalachandran, Vijaya Palaniappan, Abdul Mualim Shah Abdul Rani, Mohd Shafiq Wahab, Amar-Singh HSS Abstracts of Case Series in Perak 2007-2009 114 Sinonasal Malignant Melanocytic Melanoma: A Rare Case Report Pathma L, Philip R, Harvinder S, Manjit S 115 An Arrow In The Maxillary Sinus Harvinder S, Jenny L, Gurdeep S 116 Endoscopic Resection Of Primary Nasoseptal Chondrosarcoma Jenny L, Harvinder S, Gurdeep S 117 Nutrition Support For A Hyponatreamia Patient With Old Cerebral Vascular Accident – A Case Report Maslina Isa, Norazira Mohd Ghazali 118 Spurious WBC Count On Haematology Analyser – A Case Report Nur Azalena Jimmy Abdullah, Ida Marhainis Isahak, Kalaichelvi Muthiah 119 Kimura’s Disease Sanjay Gudwani, Geeta Kathuria, Priscilla Lourdesamy, Nor Syahida, Rajiv Singh, Vashenee 120 Modified Lung Recruitment Manoeuvre In An Infant: A Case Report Khurul Ain, Chew EL 121 Facial Cleft Lip And Palate: Sonographic Diagnosis And Associated Anomalies Ramesh V, Ravinderjit K, Japaraj RP, Mukudan K, Rohanita AZ, Chew SH 122 Foetal Anomalies Associated With Twin Pregnancies Ramesh V, Ravinderjit K, Japaraj RP, Mukudan K, Rohanita AZ, Chew SH 123 Foetal Lung Lesions: Management And Outcome Ramesh V, Ravinderjit K, Japaraj RP, Mukudan K, Rohanita AZ, Chew SH 124 Foetal Ovarian Cyst: Prenatal Diagnoses And Postnatal Outcomes Ravinderjit K, Japaraj RP, Ramesh V, Roha AZ, Chew SH, Mukudan K 125 Perinatal Outcomes After Prenatal Diagnoses Of Placental Chorioangioma Japaraj RP, Ravinderjit K, Ramesh V, Roha AZ, Chew SH, Mukudan K 126 Impact Of Delayed Diagnosis And Appropriate Management Of Churg Strauss Syndrome – Case Report Wahinuddin Sulaiman, Anwar Arshad, Sabariah Mohd Noor, Safari Ellis, Zakaria Abdul Kadir Instruction To Authors 6 Vol 9 • No 1 • 2009 Medical Practice Hospital Ipoh MEdICAl PRACTICE HoSPITAl IPoH PoSTgRAduATE MEdICAl EduCATIon SoCIETy of HoSPITAl RPB IPoH The official journal of the Postgraduate Medical HOSPITAL RPB IPOH Education Society of Hospital RPB Ipoh (Pertubuhan Pendidikan Perubatan Lepas Ijazah Hospital RPB Ipoh) and the Clinical Research Centre Perak (CRC Perak). offICE BEARERS foR 2009/2010 2009 EdIToRIAl CoMMITTEE PRESIdEnT EdIToR Dato’ Dr Chandran K Dato’ Dr Amar-Singh HSS vICE-PRESIdEnT Dato’ Dr Amar-Singh HSS EdIToRIAl BoARd Dr Shamsanah Hanif SECRETARy Lina Hashim Dr Sree Kantan Nayar Mohd Syahid Ishak ASSISTAnT SECRETARy Dr Chong Li Ann AdvISoRS Dr Zaidah bt Hussain, TREASuRER Director, Hospital Raja Permaisuri Bainun, Dr Noor Khatijah Nurani Ipoh, Perak CoMMITTEE MEMBERS Dato’ Dr Ahmad Razin bin Dato’ Dr Haji Ahmad Mahir, Dato’ Dr Subramaniam Muniandy Director of Medical & Health Services, Dato’ Dr Norain Karim Perak State Dr Japaraj Robert Peter Dr Paranthaman V Medical Practice Hospital Ipoh is a registered journal with an International Standard Serial Number (ISSN) AudIToRS issued by the National Library of Malaysia. All articles Dato’ Dr Mukudan K published, including editorials and letters, represent the Dato’ Dr Kamalasothy K views of the authors and not necessarily those of the Editorial Board or of the Ministry of Health. The Postgraduate Medical Education Society of Hospital RPB Ipoh was first conceived in 1991. It received official status with All manuscripts submitted to the journal should be in its registration in 1993. Over the years, the Postgraduate Medical accordance with the “Instructions To Authors” (printed Education Society of Hospital RPB Ipoh has been active in on the last page of the journal) and submitted to the promoting postgraduate medical education and the development address below. of facilities for such activities. This journal, the Medical Practice Hospital Ipoh, is one such activity. EdIToRIAl AddRESS: The Editor, ClInICAl RESEARCH CEnTRE (CRC) PERAk Medical Practice Hospital Ipoh, Hospital Raja Permaisuri Bainun Ipoh c/o Clinical Research Centre Perak, 4th Floor, Ambulatory Care Centre, Hospital Raja Permaisuri Bainun, 30990 Ipoh, Perak. Coordinator: Dato’ Dr Amar-Singh HSS Manager: Ms Lina Hashim Tel: +605-5222953 Members: Dr Letchuman Ramanathan Fax: +605-2425477 Dr Japaraj Robert Peter Dato’ Dr Suarn Singh Jasmit Singh We are grateful to the Director-General, Ministry of Dr Paranthaman V Health Malaysia for permission to publish the articles Dr Marina Kamaruddin in this issue of Medical Practice Hospital Ipoh. The Clinical Research Centre Perak (CRC Perak) at Hospital Hospital RPB Ipoh, is proud of its postgraduate Raja Permaisuri Bainun Ipoh, officially began functioning in activities. It was the first Malaysian government March 2001. The CRC was initially based in the 9th floor of the hospital to start a medical journal as well as set up a hospital with a computer training facility. The development of computer centre for postgraduate purposes. the Ambulatory Care Centre (ACC) has allowed the CRC to be housed at a larger facility since early 2006. Vol 9 • No 1 • 2009 7 EdItorIal Medical Practice Hospital Ipoh national Medical Research Register Lina Hashim, Amar-Singh HSS A new online vehicle was initiated and officially launched approval3. Many health professionals start out doing research in 2007 by the National Institutes of Health (NIH) of the without learning the scientific, ethical and administrative Ministry of Health (MOH) Malaysia, to drive clinical research processes that are required to obtain a meaningful result and forward in a systematic manner1. The National Medical one that will enable future publication. Research Register (NMRR) is a web-based application to According to the International Committee of Medical Journal support the implementation of the NIH’s guideline on the Editors (ICMJE), for the conduct of experimental research conduct of research in the MOH. It facilitates the researcher on human subjects, authors should apply ethical standards through research ethical approval, research funding, research of the institutional and national committees on human publication approval, etc. The NMRR enables all research experimentation and conform to the Helsinki Declaration4. conducted within MOH or by MOH staff to be accessible If doubt exists authors must explain the rationale for their in a single database to policy makers/managers, other approach and demonstrate that the institutional review researchers, sponsors of clinical trials and the public. This body (MREC) explicitly approved the doubtful aspects ensures transparency and increases public trust, allows of the study. Registering research in the NMRR will grant for policy makers to use research conducted, reduces the the researcher a national ethics board review and approval. duplication of similar research and helps sponsors identify The NMRR application and reviewer process will enable keen researchers. The NMRR is also cost and time-saving, researchers to improve the research proposal before the and improves the efficiency of managing MOH research research is implemented. activities, through tracking the progress of and speeding up of research approvals. Researchers are also offered value Research involving human subjects require prior ethics support via the NMRR. review and approval by the MREC. A human subject (in the context of research) is “a living individual about whom Via the NMRR, MOH is able to enforce and implement its an investigator obtains either data through intervention research policy in the following areas1,2: (e.g. clinical trial) or interaction (e.g. questionnaire in • Registration of all research that involves MOH health survey) with the individual, or identifiable private personnel, or that is to be conducted in MOH facilities, information”1. This Helsinki Declaration covers virtually or to be funded by a MOH research grant all forms of research conducted that involve human subjects. • Review and approval of the research by designated MOH personnel, within the NIHs, to whom authority CRC Perak would like to use this opportunity to promote the has been delegated for the purpose NMRR to all researchers in the region. Note that no research • In addition, research involving human subjects requires can be conducted in MOH without all of the following: prior review and approval by the MOH Research and a. NMRR registration Ethics Committee (MREC) b. Institutional Approval (local hospital & state) • Approval of all research publications, whether in the c. MREC approval (ethical clearance) form of research report, journal article or conference proceeding, by the NIH initially and thereafter by the REfEREnCES: Director General of MOH 1. Official Circular of the Director-General of Health, Most researchers agree that research is a vital method for Malaysia. NIH Guidelines for Conducting Research in understanding problems that affect individuals, communities the MOH Institutions & Facilities, 2007. or health systems. It allows for a systematic and scientific assessment or evaluation of the problem and often provides 2. National Medical Research Register – User instruction knowledge that allows for change to occur – change that can (www.nmrr.gov.my) improve the quality of health and health care. However many 3. Amar-Singh HSS, Azman Abu Bakar and Sondi researchers produce research proposals that are lacking in Sararaks. The Medical Research Handbook – Planning vital aspects and hence, when submitted via the NMRR, get a Research Project. 2008, Kuala Lumpur. returned for revision. The common failures include weak or limited (unclear) methodology, lack of protection of patient 4. Uniform Requirements for Manuscripts Submitted to confidentiality (data capture sheets containing patient names Biomedical Journals – Ethical Considerations in the or identification data), the lack of proper data capture sheets Conduct and Reporting of Research: Protection of or questionnaires, the absence of consent forms/patient Human Subjects and Animals in Research – http://www. information sheets and no or incomplete institutional icmje.org. Accessed 15th March 2010. 8 Vol 9 • No 1 • 2009 abstracts of Health System research in Perak 2007-2009 Medical Practice Hospital Ipoh Improving knowledge on Type 2 diabetic Patients on oral Hypoglycaemic Agents Mohd-Rohaizad Z1, Umi-Hani MA1, Mohd-Fadhil S2, Liliwati I2, Amar-Singh HSS3, Sondi Sararaks4, Ranjit K5, Asmah ZA5, Ruzita M2, Sabab H6 1Hospital Teluk Intan, 2Hilir Perak Health Office, 3CRC Perak, 4Institute for Health Systems Research, 5Perak State Health Department, 6 Hospital RPB Ipoh InTRoduCTIon RESulTS WHO has recognised diabetes mellitus as a chronic disease Patient ages ranged from 30 to 83 years old, with 60% being epidemic. The Malaysian National Health and Morbidity female and 60% Malays. Almost half of the patients were Survey II showed an increase in the percentage of Type primary schooled and majority of patients have been on OHA 2 diabetics from 6.3% in 1986 to 8.3% in 1996. Oral for an average of two years. A total of 302 patients were hypoglycaemic agents (OHA) are the important drugs used sampled at baseline, 176 at PI1 and 244 at PI2. Most patients and patient knowledge on OHA is important for better had significant improvement in overall knowledge at PI1 glucose control. The objective of this study was to improve and sustained at PI2 particularly for patients with different knowledge among diabetic patients on OHA in the outpatient duration of diabetic illness (p < 0.001) and number of OHA setting using an intervention programme comprising used (p <0.001). Further analysis done towards 2 different provider education and focused client education. facilities (health clinics and hospital setting) showed a better improvement in health setting. METHodology ConCluSIon A non-controlled, community trial on type 2 diabetic patients on OHA treatment was conducted in a district outpatient The intervention module designed was effective and showed setting, from November 2006 to August 2007, to assess the a significant improvement in overall knowledge across effectiveness of an intervention package. The intervention different socio-demographic factors. package consisted of standardised structured guidelines, OHA chart, medication explanation checklist, reminder kEywoRdS stickers for OHA envelopes and pamphlets. Outcomes were assessed on independent samples of patients via face-to-face oral hypoglycaemic agents, diabetic, improve knowledge interviews at baseline, 5 (PI1) and 8 (PI2) months post- intervention using a structured questionnaire. Respondents were recruited at the pharmacy via convenient sampling method from a sampling frame of 8,500 diabetics. Vol 9 • No 1 • 2009 9 abstracts of Health System research in Perak 2007-2009 Medical Practice Hospital Ipoh Health Seeking Behavior Towards Communicable diseases Among foreign workers In Industrial Sector And Agriculture Sector In Selected districts In Perak Koh Kean Yau1, Ong Kuo Ghee2, Noor Asmah Ahmad Shah Azizi3, Wan Asmuni Wan Mohd. Saman4, Asmah Zainal Abidin7, Marina Kamaruddin7, Amar-Singh HSS5, Sondi Sararaks6, Ranjit Kaur7 1 Hospital Sungai Siput, 2Medical Department, Hospital Taiping, 3Gerik District Health Department, 4UITM Shah Alam, 5Perak CRC, 6Institute for Health System Research, 7Perak State Health Department InTRoduCTIon study were workers with work permits (90.3%), and only 9.7% (69) were illegals. Out of the total 710 respondents, Information regarding the pattern of behaviour of foreign 70 respondents (9.85%) had experienced serious illness workers in seeking health and in their utilisation of health and another 209 respondents (29.4%) had experienced mild facilities is limited. This may hinder strategic policy illness. For those who had experienced serious illness, 68 formulation and implementation in the health system out of 70 respondents sought medical treatment (97.14%) as especially in relation to managing communicable diseases. compared to only 172 (82.3%) out of 209 respondents with Information is needed on health-seeking behaviour, mild illness. Of the 172 respondents who sought treatment barriers, accessibility and utilisation of services. This study for mild illness, an equal percentage (48.8%) of them sought was to determine the health-seeking behaviour towards treatment at government and private clinics and hospitals. communicable diseases among foreign workers in the 19.8% of respondents were admitted to hospital and 85.5% industrial and agricultural sectors in Perak. of them considered that the fees were affordable. In response to 4 clinical scenarios (PTB, malaria, cholera and typhoid METHodology symptoms), they would seek appropriate health care. The majority of foreign workers from the plantations (82.5%) A cross-sectional community survey was done to look at needed to travel more than 20 km whereas 93.7% from the health-seeking behaviour towards communicable diseases industrial sector only needed to travel less than 5 km to among foreign workers in the agricultural sector from Hulu seek treatment. Perak and Kuala Kangsar districts and industrial sectors from Kinta district in Perak. Purposeful sampling was conducted ConCluSIon to ensure that all relevant sectors and ethic groups were included. The study gathered information through interviews This study showed that foreign worker does not seem to have or were self-administered using a standardised, pre-test problems in seeking health care. Access to care is a problem questionnaire. Health-seeking behaviour for reported in the plantation sector in term of geographical location. Both illnesses of foreign workers and for possible communicable legal and illegal worker seek health care for their serious illnesses (4 clinical scenarios) were evaluated. Availability, and mild illness. Legal and illegal foreign worker appears accessibility and choice of health care services as well as to understand serious illness and take appropriate action perceived obstacles were assessed. accordingly. There is a need to improve access to health care for plantation workers. RESulTS kEywoRdS 710 foreign workers were interviewed. The majority of respondents were from Bangladesh (30.4%), followed by health-seeking behaviour, foreign workers, industrial and Indonesia (27.7%), Thailand (16.9%), Nepal (14.1%) and agricultural sector, communicable diseases Vietnam (10.8%). A total of 338 (47.9%) workers were in the agricultural sector and 372 (52.4%) were in the industrial sector. 328 (46.2%) were from Hulu Perak, 331 (46.6%) from Kinta and 51 (7.2%) from Kuala Kangsar districts. Most of the respondents who participated in this 10 Vol 9 • No 1 • 2009