Pusat Pengajian Sains Perubatan - Tesis

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Intracranial volume post cranial expansion surgery using 3D CT scan imaging in children with craniosynostosis
(2019)
Sulong, Shukriyah
Background: Craniosynostosis is a congenital defect that cause one or more suture to fuse prematurely. Cranial expansion surgery which consist of cranial vault reshaping with or without fronto-orbital advancement (FOA) is done to correct the skull to a more normal shape of the head as well as to increase the intracranial volume. Therefore, it is important to evaluate the changes of intracranial volume (ICV) after the surgery and the effect of surgery both clinically and radiologically. Objective: This study is to (1) evaluate the ICV in primary craniosynostosis patients after the cranial vault reshaping with or without fronto-orbital advancement and to compare between syndromic and non-syndromic synostosis group, (2) to determine factors that associated with significant changes in the ICV postoperative, and (3) to evaluate the resolution of copper beaten sign and improvement in neurodevelopment after the surgery. Method: A prospective observational study of all primary craniosynostosis patients who underwent operation cranial vault reshaping with or without FOA in Hospital Kuala Lumpur from January 2017 until Jun 2018. The ICV preoperative and postoperative was measured using the 3D CT imaging and analysed. The demographic data, clinical and radiological findings was identified and analysed. Result: 14 cases (6 males and 8 females) with 28 3D CT scan were identified. The mean age of patients was 23 months. The patients were 7 syndromic synostosis (4 Crouzon syndrome and 3 Apert syndrome) and 7 were non-syndromic synostosis. The mean preoperative ICV was 880 mL (range, 641-1234 mL) while the mean postoperative ICV was 1081 mL(range,811-1385 mL) The difference was 201 mL which was statistically significant (P<0.001). In comparison, the mean volwne increment for syndromic synostosis and non-syndromic synostosis were 282 rnL and 120 rnL respectively. The difference was statistically significant (P<0.004). Mc Nemar's test was used to analyse pre and post-operative changes within the same patients. At 3 months post-surgery, all 13 patients with copper beaten sign pre-operatively did not show complete resolution on 3D CT imaging. Therefore the p-value was insignificant (P> 1.0). While 2 patients with neurodevelopmental delay pre-operatively showed no improvement during assessment at 3 months post-surgery. Again the p-value was insignificant (P> 1.0). Hence, there were no significant resolution in copper beaten sign and improvement in neurodevelopmental delay in this study. Conclusion: Surgery m craniosynostosis patients increases the intracranial volume besides it improves the shape of the head. From this study, the syndromic synostosis had better increment of intracranial volume compared to non-syndromic synostosis.
Perceptions, problems faced and coping behaviour : a qualitative exploration among patients with breast cancer attending Hospital USM, Kubang Kerian, Kelantan
(2018-07)
Jafar, Noor Hayati
Patients with breast cancer face many challenges which include coming to terms with the diagnosis, managing treatment regimens, dealing with the side effects of treatment, conducting self-care and rehabilitation. In addition, the underlying belief of the disease influenced their health seeking behaviours. Each individual may have different coping strategies in order to overcome her problem. The study aimed to explore perceptions, problems, and coping behaviours among patients with breast cancer, and to develop Self-study Health Education Module for patients with breast cancer. Patients were purposively recruited from the Outpatient Oncology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Selected patients were interviewed in-depth until saturation were achieved. All interviews were tape-recorded and transcribed verbatim. Qualitative data were managed by Nvivo 10.0 software. Descriptive analysis was performed using SPSS version 22. A total of 34 patients took part in the study. Majority were married (85.3%), Malay (88.2%), age between 40 to 59 years old (70.6%), secondary school education (73.5%), housewife (61.8%), diagnosed with right breast cancer (52.9%) and with monthly income of less than RM 1500 (67.6%). The qualitative findings were divided into three sections which included patients’ perceptions regarding breast cancer, their problems and coping behaviours in patients with breast cancer. The themes raised from patients’ perceptions regarding breast cancer were cancer is viewed cancer as a death penalty; cancer treatment is terrifying and cancer as curable disease. The themes emerged regarding problems faced among patients with breast cancer were emotional, physical, and social relationship changes, economical restraint, and prioritise traditional over modern medicine. Three main themes emerged regarding coping behaviours were emotional-focused coping, spiritual-focused coping and problem-focused coping. Based on the study findings and literature search, a new Self-study Health Education Module was developed. Eleven experts viewed the module as good, very informative, helpful, suitable to implement and easy to understand. Mean scores of evaluations ranged from 3.5 (graphics are interesting) to 4.2 (module in line with objectives). Ten patients viewed the module as good, very interesting, clear, helpful, and easy to understand. Mean scores of evaluations ranged from 4.2 (pictures are interesting) to 4.8 (information are sufficient, beneficial). Health professional should also spend more time on counselling, conducting seminar and others activities to educate and improve awareness regarding breast cancer.
Development and validation of IYCF-CCPQ to assess knowledge, attitude and practice (KAP) on infant and young child feeding and factors associated with the kap scores among child care providers in Kelantan
(2019-01)
Zakria, Najihah Mahfuzah
Adequate nutrition is critical to child health. There is a need to identify the knowledge, attitude, and practice (KAP) on infant and young child feeding among child care providers. Pre-existing questionnaires are unsatisfactory due to a different target population, weak theory, and lack of confirmatory analysis. Our objectives were t o develop and validate a new questionnaire that will be use d to assess the KAP and its associated factors among child care provider s in Kota Bharu. This study consists of two phases which Phase 1 developed and validate a new questionnaire, meanwhile Phase 2 involved assessment of KAP and its associated factors. The questionnaire was developed based on literature review, experts’ opinion and theoretical framework. Response process was assessed via cognitive debriefing and pretesting. Psychometric validation was carried out among 200 child care providers outside Kota Bharu. Purposive sampling was applied. Item Response Theory and Exploratory Factor Analysis were used for internal structure validity . Internal consistency rel iability was conducted for all domains. For Phase 2, a cross-sectional study involved 150 child care providers in Kota Bharu. Multistage random sampling was applied. Level of KAP was determined and its associated factors were identified through multiple linear regression and chi-square analysis. As a result, the new questionnaire consists of 218 final items with 3 domains (99 items on knowledge, 77 items on attitude, and 42 items on practice) and named as ‘Borang Kaji Selidik Pemakanan Bayi dan Kanak-Kanak dalam kalangan Pengasuh’ or IYCF-CCPQ. IYCF-CCPQ had good psychometric properties. Internal consistency by marginal reliability ranging from 0.74 to 0.91 for domain knowledge. Reliability for domain attitude ranging from 0.89 to 0.90. Breastfeeding and formula feeding knowledge score (BFFKS) was 69.42 (SD 11.31), complementary feeding knowledge score (CFKS) was 76.99 (SD 9.31), breastfeeding and formula feeding attitude score (BFFAS) was 143.61 (SD 12.10); and complementary feeding attitude score (CFAS) was 176.69 (16.07). Exclusive breastfeeding experience (adjusted b=7.09; 95%CI 1.69,12.48; p=0.001) and number provider per centre (adjusted b=-0.41; 95%CI -0.77,-0.06; p=0.022) did had association with BFFKS. Being married had significant association with BFFKS (adjusted b=6.01; 95%CI 2.32,9.71; p<0.001), BFFAS (adjusted b=5.33; 95%CI 1.40,9.26; p=0.008) and CFAS (adjusted b=7.69; 95%CI 2.94,12.45; p=0.002). Increased total working hours per day (adjusted b=2.53; 95%CI 1.06,4.00; p<0.001) did have association with CFKS. Diploma or higher qualification did influence CFKS (adjusted b=3.13; 95%CI 0.08,6.19; p=0.046), BFFAS (adjusted b=5.33; 95%CI 21.40,9.26; p=0.008) and CFAS (adjusted b=10.74; 95%CI 5.69,15.79; p<0.001). Job scope less than five did influence CFKS (adjusted b=4.67; 95%CI 1.79,7.54; p=0.001), BFAS (adjusted b=3.94; 95%CI 0.29,7.58; p=0.036) and CFAS (adjusted b=8.24; 95%CI 3.53,12.94; p<0.001). Source information from health staff did influence CFKS (adjusted b=3.16; 95%CI 0.05,6.27; p=0.048). Meanwhile, pamphlet source had association with CFAS (adjusted b=5.89; 95%CI 0.79,11.00; p=0.025). There was a significant association of educational level (X2=8.12(3),p=0.044) and exclusive breastfeeding (p=0.041, fisher exact test) with the practice of handling express breastmilk. Meanwhile, hygenic practice did have association with educational level (p=0.048, fisher exact test). In conclusion, the IYCF-CCPQ is reliable and valid to be used to assess KAP among child care providers on infant young child feeding. Overall KAP was satisfactory and identified significant factors help in improving child care providers’ KAP in future.
Evaluation of high-dose rate (HDR) radiobiologic dose-equivalent web tool for cervical cancer
(2024-07)
Shafizan, Haziq Asyraaf
Following successful precision and timing accuracy phases, the next step is a comprehensive evaluation of the web application versus the Microsoft Excel template. Testing with clinical data ensures robustness. Documentation and training for medical physicists are essential. Implementation will start with a pilot group, followed by full-scale deployment. Evaluation of BED and EQD2 values reveals minimal deviations, indicating high comparability. For target tissue, BED deviation is 0.048% and EQD2 is 0.008%. The bladder shows a BED deviation of 0.055% and EQD2 of 0.073%. The rectum has a BED deviation of 0.014% and EQD2 of 0.029%. For the sigmoid, the BED deviation is 0.035% and EQD2 is 0.142%. All deviations are within the 3% tolerance limit. The web application completes the full treatment in 138.69 seconds, compared to 202.67 seconds for Excel, with a TER of 1.46. For the first additional patient, the web application takes 96.84 seconds, while Excel takes 107.11 seconds, giving a TER of 1.11. For the second additional patient, the web application takes 94.77 seconds versus 78.66 seconds for Excel, with a TER of 0.83. Despite occasional exceptions, the web application is generally more time-efficient and reliable.
Nurses’ perceptions of patient handoffs and its predictors in public hospitals with specialists in Kelantan: a cross-sectional study
(2023-06)
Nawawi, Mohd Hanif Mohd
Introduction: Understanding the significance of proper handoff process will help to reduce medical errors and enhance patient safety concerns. Thus, the purpose of this study was to investigate nurses' perceptions of patient handoffs in public hospitals with specialists in Kelantan and its predictors. Methodology: This cross-sectional study examined nurses from three specialist hospitals in Kelantan, Malaysia. The nurses were proportionately and randomly selected from the hospitals and included in the study. The nurses had at least six months of work experience and worked shifts at public hospitals with specialists in Kelantan. The study used a self-administered questionnaire with 26 items from six domains, which was validated and scored using a 5-point Likert scale. The data was analyzed using SPSS version 25 and linear regression analyses were used to identify predictors of nurses' perceptions of handoffs. Results: A total of 418 nurses participated in the study. The results indicate that nurses hold a positive view of handoffs, with a mean score ± SD of 3.53 ± 0.31. The mean age of the participants was 41.06 ± 6.26 years, the mean working experience was 16.80 ± 6.12 years and the mean handoff duration was 24.39 ± 10.68 minutes. The study identifies the paediatric department (95% CI: -0.195, -0.053, p <0.001), in-service formal training on handoff (95% CI: 0.016, 0.161, p <0.05) and satisfaction with the handoff process (95% CI: 0.234, 0.425, p <0.001) as the most significant predictors of nurses' perceptions. Conclusion: The study found that nurses generally perceived patient handoffs positively, with predictors including the paediatric department, handoff training and satisfaction with the process. To maintain good handoff practices, ongoing education, teamwork, audits and safety-focused culture are important.

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