Shaik Farid Abdull Wahab

A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia

BackgroundWe performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia.MethodsThis was a prospective intervention study. The primary endpoint of the study was to determine the level of KA about resuscitation after CPR training. The six schools and classes from selected schools were chosen by randomization among the form three and four classes using sealed envelopes. A fully validated questionnaire consisting of three sections (sociodemographic, knowledge and attitude) was given to the pupils before and 2 weeks after the intervention. The intervention group was given a lecture, video show, pamphlet and 1-h practical session on CPR training. The control group received a placebo in order to overcome the learning effect. The maximum scores for the knowledge and attitude sections were 72 and 28, respectively. Repeated measures ANOVA analysis was used for specific objectives to determine the changes in knowledge and attitude level pre- and post-intervention for both study groups. P-values less than 0.05 were taken as significant at 95% confidence intervals.ResultsThe mean (SD) total knowledge scores for the intervention (n = 216) and control (n = 252) groups were 62.43 (13.68) and 62.29 (12.11), respectively (maximum score 72) (p > 0.05). On the other hand, the mean (SD) total attitude scores for the intervention and the control groups were 19.33 (4.51) and 17.85 (4.52), respectively (maximum score 28) (p < 0.001). There were significant differences in mean knowledge and attitude scores between the intervention and control groups with regard to time (pre- and post-intervention). The mean difference in knowledge and attitude scores between both study groups was 8.31 (p < 0.001) and 2.39 (p < 0.001), respectively.ConclusionsThe level of knowledge and attitudes of secondary school children was shown to be acceptable prior to the intervention. Furthermore, a brief CPR training program improved their level of knowledge and attitudes significantly as compared to those who had never been trained.

A simple culture method for epithelial stem cells derived from human hair follicle

The challenge arises among researchers when hair follicle stem cells (HFSCs) derived from a human hair follicle remain poorly expanded in defined culture medium. In this study, we isolated the HFSCs and they became confluent after 10 days of cultivation. Comparing the viability of HFSCs cultured in defined keratinocytes serum free medium (KSFM) in a coated plate and CnT07 medium in an uncoated plate, the number of HFSCs cultured in CnT07 was significantly higher at days 2, 4, 6 and 8 (P=0.004). The population doubling time of HFSCs was 21.48±0.44 hours in non-coated plates with CnT07 and 30.73±0.75 hours in coated plates with KSFM. Our primary HFSC cultures were positive for CD200 and K15 with brownish color. Flow cytometry analysis showed that the percentage of HFSCs expressing CD200 and K15 were 65.20±3.16 and 72.07±6.62 respectively. After reaching 100% confluence, the HFSCs were differentiated into an epidermal layer in vitro using CnT02-3D defined media. HFSCs were differentiated into an epidermal layer after 2 weeks of induction. Involucrin- and K6-positive cells were detected in the differentiated epidermal layer. This method is a simple technique for HFSC isolation and has a lower cost of processing and labor, and it represents a promising tool for skin tissue engineering.

CPR: Bright Side of Machine-Human Relationship

Cardio pulmonary resuscitation (CPR) is a common procedure at Accident and Emergency Department, especially in the Red Zone or Resuscitation Room. This procedure is done as a method to save patients’ life, especially in the event of cardiac arrest. Medical doctors or nurses do continuous cycles of chest compressions manually in order to ensure the heart keep pumping. This is vital in making sure blood supply to the heart and brain is not interrupted. The external force needed to compress the chest is a result of continuous pressing of the heart at the level of mid chest. One cannot deny, the process can be exhausting and can cause muscular pain to the medical doctors or nurses. However, with innovation and technology, nowadays, CPR can be done using machine. The objective of this study is to justify how the relationship of human and machine, has not only save patients life, but also able to safe the medical doctors and nurses from the risk of musculoskeletal disorder (MSD). This study has been carried out at Red Zone of Accident and Emergency Department, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia. During this study, 10 medical doctors participated. 8 females and 2 male doctors were voluntarily involved in this study. All of them were asked to perform CPR while standing on the floor and while standing on a stool and patient lying on the bed. Their body postures were recorded and score were given based on Rapid Entire Body Assessment (REBA). This score will determine whether they might have the risk of MSD due to performing CPR or not. For this study, a mannequin was used instead of real patient. Two mechanical CPR device machines were selected in this study, which were LUCAS and AutoPULSE. CPR by these machines was also performed on the mannequin. Result showed, REBA scores are high risk and very high risk. The REBA score when performing CPR while standing on stool were higher compared to REBA score when performing CPR while standing on the floor. Thus, the existing machine-like LUCAS and AutoPULSE in doing CPR not only save patients life, but also have helped the medical doctors and nurses as well. The teaming between machine and human in this study has proven to bring benefits to human life, especially to the medical doctors and nurses.

Lighting Assessment at Resuscitation Area of Accident and Emergency Department, Universiti Sains Malaysia

Lighting is one of the environment factors that are important. Good and adequate lighting ensure proper task can be done successfully. Properly designed lighting will allow workers to work better with less risk of occupational hazard. The important of natural lighting is undeniable. However, there are certain buildings that have to depend on artificial lights only. The purpose of this study is to evaluate the lighting at resuscitation area of Accident and Emergency Department. Resuscitation area is one of area at the Red Zone where all the patient resuscitation will take place. This study had been carried out at Resuscitation Area, Accident and Emergency Department of Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia. The existing lightings were evaluated using a lux meter (light meter). The evaluation was a procedure-based approached and carried out on the beds at where procedures were done. Since procedures were done on bed, the bed area was divided into six (6) equal squares. The light sensor was placed at the center of each squares and reading were recorded. Measurement from floor to the bed surface was also measured. Data from the lux meter will be compared with the existing guideline. The findings revealed that lighting in this zone were not designed based on tasks requirements, thus justified the additional lights added later.

Nurse Station of Accident and Emergency Department, USM

Every ward at any departments in hospital will have a nurse counter. Nurse counter or nurse station is a determined place for nurses to do their deskwork. Urgent phone calls and note writing, are among common activities done at the station. Sometimes, discussions and short meeting are also done at the nurse station. Despite the name, this workstation is also used by medical officers, even specialist when they need to sit and write. A usual set of computer and printers, as well as stationeries and telephone are placed at this station. Chairs are also provided. Files and forms are also available at the station. Some stations have both sitting and standing counters for nurses or medical officers to do their works. This objective of this study is to evaluate the current condition of nurse station at Red Zone of Accident and Emergency Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Measurement of the nurse station was taken during the evaluation. The body postures of personnel at the counter were observed. The lighting at the station was also recorded. This study is needed because nurse station is an important part at Accident and Emergency Department. The evaluation result shows, this area was not given a fair attention despite its important. This study justified how the current condition of nurse station has been overlooked and immediate attention should be given in order to ensure better working condition at the station.

Ergonomics Risk Assessment of Musculoskeletal Disorders (MSD) During Simulated Endotracheal Intubation in Hospital Universiti Sains Malaysia (HUSM)

Endotracheal intubation is an important procedure in emergency medicine. This procedure is done as a method to secure the airway of patient during cardiac arrest. Body posture during intubation may cause musculoskeletal disorders, but doctor do not have awareness about effect of ergonomic factors on their health. There is a rise in prevalence of work related musculoskeletal disorder (MSD) in medical personnel performing any procedure due to lack of physical ergonomic. There is little evidence on optimum bed level for intubation in association with ergonomic body posture. This study was performed to evaluate the effect of different bed level during endotracheal intubation on ergonomic risk using REBA methods and to find optimum level for intubation with less risk of MSD. This cross sectional study was performed among 30 emergency residents using REBA methods. This study has been carried out at red zone of accident and emergency department Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan. During this study, 30 doctors were asked to performed endotracheal intubation using a mannequin at 3 different bed levels: supra pubic, umbilical and sub-xyphoid level. At each level, their body posture was recorded and score were given based on REBA. We compared mean REBA score for each level. This study showed that high risk and very high risk for MSD when intubation was performed at the level of supra-pubic and umbilical. However, the score for sub-xyphoid was low risk for MSD. As a conclusion, we should advise the medical personnel to intubate patient at a sub-xyphoid level.

Risk of Musculoskeletal Disorders (MSD) in Rescuer Performing CPR at Kneeling, Standing and Step-on-Stool Position

CPR is a live-saving procedure commonly performed in emergency department. Chest compression is a crucial component of CPR requires the rescuer to provide large force at certain rate. Emergency medical staff frequently needs to perform CPR in uncomfortable and awkward position such as kneeling on the floor or stretcher, standing in moving ambulance and standing on step-stool. Musculoskeletal pain and fatigue are often reported among rescuer after performing. The study aimed to assess the ergonomic risk factor of musculoskeletal disorders in rescuer performing chest compression at 3 different positions: kneeling, standing and step-on-stool. A cross-sectional study involving 30 participants consist of emergency doctors, nurses and paramedic was carried out in Emergency and Trauma Department of Hospital Universiti Sains Malaysia, Kelantan. All participants were required to perform chest compression on mannequin each at kneeling, standing and step-on-stool position. Participants are video graphed while performing high-quality CPR. Ergonomic risk score is assessed by using Rapid Entire Body Assessment (REBA) tool. This study showed that the highest mean REBA score recorded at kneeling position, followed by standing position and step-on-stool position. Mean REBA score at all 3 positions belongs to high risk group and it is necessary to further investigate and implement change as soon as possible.

Considering Ergonomics in the Accident and Emergency Department: Possible or Not

Accident and Emergency Department is one of the medical treatment departments that deal with emergency medicine, where patients come without making any appointment in advance. In Malaysia, it was known as Casualty Department previously. The nature of Accident and Emergency Department is complex due to the unpredictability of this department, Accident and Emergency Department is a workplace for multiple types of individuals. This study looked into the numbers of studies that has been carried out in area of ergonomics at Emergency Department of Malaysia Hospitals compared to other department. Numbers of studies are compared to see the loop that exists in Accident and Emergency Department when it comes to ergonomics. This paper will see the ergonomics issues face by healthcare personnel compares to other department in hospitals. Findings showed that, Accident and Emergency Department of Malaysia Hospitals has not been given enough attention regarding the implementation or ergonomics.