Ismail Mohd Saiboon

Disaster management: a study on knowledge, attitude and practice of emergency nurse and community health nurse

Background Disasters are unpredictable events that kill and affect people, demolish properties and disrupt environment. During such events, nurses play a vital role in dealing with the victims. It is therefore crucial for nurses to be prepared in facing the aftermath of disasters. The aim of this study was to determine knowledge, attitude and practice of emergency nurse and community health nurse towards disaster management. Materials and methods This was a cross-sectional study conducted in emergency departments and health clinics in Selangor, one of the states in Malaysia. Questionnaire forms eliciting information about knowledge, attitude and practice towards disaster management were randomly distributed to 468 nurses working at the aforementioned clinics. This survey was conducted from October to November 2011 and yielded a response rate of 84.6 per cent. Results Both groups of nurses had similar inadequate knowledge but portrayed positive attitude towards disaster management. They differ in terms of practice whereby 56.1% of emergency nurses reported having had adequate practice compared to 30.7% of the community health nurses (chisquared test, P<0.001). Emergency nurses who have been involved in disaster response are more likely to report adequate practice (P<0.01, AOR=4.008, 95% CI=1.691- 9.504) while those who attended disaster-related education/training are more likely to have adequate knowledge (P<0.05, AOR=3.807, 95% CI=1.584-9.153) and practice (P=0.001, AOR=4.145, 95% CI=1.804- 9.525). Attending disaster-related education/training is seen to be a predictor to adequate knowledge (P<0.001, AOR=3.511, 95% CI=2.097-5.881) and practice (P<0.001, AOR=4.080, 95% CI=2.326-7.156), and portraying positive attitude (p<0.05, AOR=2.042, 95% CI=1.025-4.069) among community health nurse. Nurses’ workplace (represent type of nurse) is identified as a predictor for the adequacy of practice (P<0.001, AOR=2.345, 95% CI=1.474-3.730). Conclusions Adequacy of knowledge and practice, and portraying positive attitude is driven by being involved in disaster response and attending disaster-related education. It is therefore paramount for health administrators to conduct disaster-related education/training for front-liners such as emergency and community health nurses to improve their knowledge and practice towards disaster management.

Comparison of adaptive neuro-fuzzy inference system and artificial neutral networks model to categorize patients in the emergency department

Unexpected disease outbreaks and disasters are becoming primary issues facing our world. The first points of contact either at the disaster scenes or emergency department exposed the frontline workers and medical physicians to the risk of infections. Therefore, there is a persuasive demand for the integration and exploitation of heterogeneous biomedical information to improve clinical practice, medical research and point of care. In this paper, a primary triage model was designed using two different methods: an adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network (ANN).When the patient is presented at the triage counter, the system will capture their vital signs and chief complains beside physiology stat and general appearance of the patient. This data will be managed and analyzed in the data server and the patient’s emergency status will be reported immediately. The proposed method will help to reduce the queue time at the triage counter and the emergency physician’s burden especially duringdisease outbreak and serious disaster. The models have been built with 2223 data set extracted from the Emergency Department of the Universiti Kebangsaan Malaysia Medical Centre to predict the primary triage category. Multilayer feed forward with one hidden layer having 12 neurons has been used for the ANN architecture. Fuzzy subtractive clustering has been used to find the fuzzy rules for the ANFIS model. The results showed that the RMSE, %RME and the accuracy which evaluated by measuring specificity and sensitivity for binary classificationof the training data were 0.14, 5.7 and 99 respectively for the ANN model and 0.85, 32.00 and 96.00 respectively for the ANFIS model. As for unseen data the root mean square error, percentage the root mean square error and the accuracy for ANN is 0.18, 7.16 and 96.7 respectively, 1.30, 49.84 and 94 respectively for ANFIS model. The ANN model was performed better for both training and unseen data than ANFIS model in term of generalization. It was therefore chosen as the technique to develop the primary triage prediction model. This primary triage model will be combined with the secondary triage prediction model to produce the final triage category as a tool to assist the medical officer in the emergency department.

Emergency skills learning on video (ESLOV): A single-blinded randomized control trial of teaching common emergency skills using self-instruction video (SIV) versus traditional face-to-face (FTF) methods

Background: Self-instruction video (SIV) has been widely explored as a teaching mode for cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), but not with other basic emergency skills. Aim: To evaluate the effectiveness of SIV in teaching other basic emergency skill in comparison with traditional face-to-face (FTF) methods. Methods: Participants were randomized into SIV and FTF groups. Each group was assigned to learn basic airway management (BAM), cervical collar application (CCA), manual cardiac defibrillation (MCD), and emergency extremity splinting (EES) skills. Confidence level was assessed using questionnaires, and skills performances were assessed using calibrated-blinded assessors through an Objective Structured Clinical Examination (OSCE). Results: Forty-five participants took part in the assessment exercises. There were no significant differences between both groups, on all four skill categories. The mean OSCE-score of an individual category between the FTF-group vs. the SIV-group were as follows: BAM (10.23 ± 1.04 vs. 10.04 ± 1.49; p = 0.62); CCA (7.86 ± 4.39 vs. 7.13 ± 4.12; p = 0.57); MCD (8.24 ± 0.89 vs. 7.58 ± 1.14; p = 0.39); EES (5.43 ± 2.11 vs. 4.63 ± 2.30; p = 0.23). The composite mean score for the FTF-group was 6.85, and for the SIV-group was 6.20 (p < 0.05). There was no significant different in the level of confidence for both groups. Conclusion: SIV is as effective as FTF in teaching and learning basic emergency skills.

Initialization of adaptive neuro-fuzzy inference system using fuzzy clustering in predicting primary triage category

This paper describes the fuzzy clustering method to initialize the Adaptive Neuro-Fuzzy Inference System (ANFIS) in predicting primary triage category. Fuzzy C-means (FCM) and Fuzzy Subtractive clustering (FSC) are the most commonly used unsupervised clustering methods to initialize the ANFIS model. A total of 135 data was extracted from Objective Primary Triage Scale (OPTS) records obtained from Emergency Department UKMMC. These data was used to develop the ANFIS model and predict the primary triage category. The classification accuracy of the ANFIS model using fuzzy clustering method in predicting the primary triage category is 98.4%. The FCM method produced fewer rules and needed less processing time to reach the RMSE of 0.127 compared to the FSC method. These results suggest that FCM clustering will be used to predict the primary triage category.

Effectiveness of teaching automated external defibrillators use using a traditional classroom instruction versus self-instruction video in non-critical care nurses

Objectives: To evaluate the effectiveness and retention of learning automated external defibrillator (AED) usage taught through a traditional classroom instruction (TCI) method versus a novel self instructed video (SIV) technique in non-critical care nurses (NCCN). Methods: A prospective single-blind randomized study was conducted over 7 months (April-October 2014) at the Universiti Kebangsaan Malaysia Medical Center, Kuala Lampur, Malaysia. Eighty nurses were randomized into either TCI or SIV instructional techniques. We assessed knowledge, skill and confidence level at baseline, immediate and 6-months post-intervention. Knowledge and confidence were assessed via questionnaire; skill was assessed by a calibrated and blinded independent assessor using an objective structured clinical examination (OSCE) method. Results: Pre-test mean scores for knowledge in the TCI group was 10.87 ± 2.34, and for the SIV group was 10.37 ± 1.85 (maximum achievable score 20.00); 4.05 ± 2.87 in the TCI and 3.71 ± 2.66 in the SIV (maximum score 11.00) in the OSCE evaluation and 9.54 ± 3.65 in the TCI and 8.56 ± 3.47 in the SIV (maximum score 25.00) in the individual’s personal confidence level. Both methods increased the mean scores significantly during immediate post-intervention (0-month). At 6-months, the TCI group scored lower than the SIV group in all aspects 11.13 ± 2.70 versus 12.95 ± 2.26 (p=0.03) in knowledge, 7.27 ± 1.62 versus 7.68 ± 1.73 (p=0.47) in the OSCE, and 16.40 ± 2.72 versus 18.82 ± 3.40 (p=0.03) in confidence level. Conclusion: In NCCN’s, SIV is as good as TCI in providing the knowledge, competency, and confidence in performing AED defibrillation.

The role of an emergency department short-stay ward in the management of dengue fever: A case-control study in a university hospital

Objective Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Methods A retrospective study was carried out on suspected dengue patients who were admitted to UKMMC EDSSW, between January and March 2010. Data were retrieved from the EDSSW Monthly Census Book and patients’ medical records. Patients were categorized as follows: group 1, which included patients who received treatment in the EDSSW only, and group 2, which included patients who received initial treatment in EDSSW and were subsequently admitted to the inpatient (IP) wards. Results A total of 147 patients’ records were available. The total length of stay was 32.2 h in group 1 and 100.5 h in group 2. For group 2 patients, a median of 21.8 h was spent in EDSSW and 78.8 h was spent in IP. All patients in group 1 and group 2 were discharged well. The total EDSSW stay was 4309 patient-hours; IP stay totalled 5137 patient-hours. The use of the EDSSW reduced the IP burden in managing dengue by 45.6%. Conclusion EDSSW limit the number and burden of dengue patients requiring formal IP admissions while acting as a ‘safety net’ for inappropriate discharges and unnecessary admissions.

A bite by the Twin-Barred Tree Snake, Chrysopelea pelias (Linnaeus, 1758).

Introduction. The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species. Case report. The patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis. Discussion . The properties of Duvernoys secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia. Conclusion. Such a facility could expedite safe and appropriate management of envenomed patients.

How do people cope with post traumatic distress after an accident? The role of psychological, social and spiritual coping in Malaysian Muslim patients

Abstract Introduction: Post traumatic distress, acute stress disorder and even post traumatic stress disorder may occur following traumatic events such as a motor vehicle accident (MVA). Instead of presenting to mental health service, many turn to psychosocial and spiritual strategies to cope with symptoms. The objective of this study is to explore the psychosocial and spiritual coping strategies utilised by MVA victims to deal with the distressing post traumatic symptoms. Methods: An exploratory qualitative study using individual in-depth interview was conducted from May to September 2015. Purposive sampling was done to optimise wide exploration. Only Muslim participants were included. The interviews were recorded, transcribed verbatim and analysed using thematic approach. Results: All participants interviewed employed psychological, social and spiritual coping strategies to help manage their post traumatic stress symptoms. Positive thinking and rationalisation are examples of psychological coping mechanisms used. Many have supportive families. Common spiritual coping strategies practised include the use of different Quranic verses and prayers. Conclusion: Psychosocial and spiritual coping strategies are popular, highly tolerable and useful for post traumatic distress. Psycho-socio-spiritual therapy may be an effective treatment for post traumatic stress in Muslim Malaysian patients. Further research is needed in this area.

Diagnosing Pediatric Intussusception Through Bedside Ultrasound by Novice Emergency Department Sonographers: A Case Report

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.

Paramedics' Perception on Video Assisted Learning Method in Learning Emergency Skills

Information technology use in healthcare education has become a popular medium of instruction. One of the medium of instruction is video assisted learning (VAL). The use of VAL as an instructioemergency skills is not new. However, there are lack of studies on the perception of using this method in learning emergency skills. This qualitative study involved four focused discussion groups following a VAL instruction on emergency skills. A total of 20 paramedics were divided into four groups. They were involved in a focussed discussion after a VAL instruction session. Findings reveal that the paramedics perceived three major themes which were categorized as : i) advantages of video as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on using video as teaching tool. The findings indicate that the paramedics perceived VAL as a potential tool for learning emergency skills. However, they suggested the language of instruction should be in their mother tongue for better understanding. This implies that using English language has disadvantage in technology enhanced learning for better understanding.