Multilevel Modeling of Individual and Group Level Influences on Critical Thinking and Clinical Decision-Making Skills among Registered Nurses: A Study Protocol.

Critical thinking and clinical decision-making are two essential components of nursing services. The practice of nursing requires both components at every level of nurses' daily tasks. This paper describes the protocol for an ongoing project, which aims to examine the prevalence of critical thinking and clinical decision-making among registered nurses and determine the factors that influence the skills at individual and group levels using a multilevel modeling approach. Survey data will be collected from approximately nine states, with nine general hospitals, nine district hospitals, one private hospital, and one educational hospital in Malaysia included. We aim to recruit 800 registered nurses working shifts in hospital settings. We will use questionnaires to measure the perceived nurses' knowledge, critical thinking skills, and clinical decision-making skills. The study will have three levels as the nurses are nested within the unit and further nested within the hospitals. This study will give an insight into the nursing profession today where critical thinking and clinical decision-making skills can play a significant role in patient safety and the quality of care in nursing practice.

Passage Number of 4T1 Cells Influences the Development of Tumour and the Progression of Metastasis in 4T1 Orthotopic Mice.

Background: The study was aimed to elucidate the influence of passage number of 4T1 cells for the development of the ideal tumour model. Methods: A total of 24 female BALB/c mice was divided equally into three groups: i) control (phosphate buffered saline [PBS] only); ii) group A (subjected to 4T1 cells of passage number 9) and iii) group B (subjected to 4T1 cells of passage number 10). The injections were introduced at the 3rd mammary pad of the mice. The net volume of the tumours was examined. Histopathological analysis was conducted to compare the extent of metastasis in the different groups of mice. Results: Group B had a higher net volume of 4T1 tumour as compared to group A (P = 0.042). The coefficient of variation in the net volume of 4T1 tumour for group A was higher (135.3%) as compared to group B (40.79%). Group A only exhibited metastasis on the lungs, liver and spleen whereas group B showed metastasis to the heart, spleen, lungs and liver. Conclusion: The use of 4T1 cells from passage number 10 is more ideal for the development of 4T1 tumour.

The Concurrent Validity and Reliability of Single Leg Squat Among Physically Active Females with and without Dynamic Knee Valgus.

Background: The single leg squat (SLS) motion imitates various maneuvers in sports. It is commonly used as a functional test for the lower limb. SLS with two-dimensional (2-D) video analysis is regularly performed in the clinical setting to assess dynamic knee valgus (DKV). However, 2-D video analysis may not be able to demonstrate the same level of accuracy as three-dimensional (3-D) motion analysis. Purpose: This study aimed to determine the within- and between-day reliability as well as the concurrent validity of 2-D and 3-D motion analysis of lower limb kinematics during 45° and 60° SLS among physically active females with and without DKV. Study Design: Cross-sectional study. Methods: A total of 34 physically active females (17 individuals with excessive DKV and 17 without DKV) participated in the study. Their DKV was determined based on the cut-off values of knee frontal plane projection angle during drop landing. Their lower limb kinematics during SLS at 45° and 60° knee flexion were captured simultaneously by digital cameras (2-D motion capture) and infrared cameras (3-D motion capture). Intraclass Correlation Coefficient (ICC) was used as an indicator for within- and between-day reliability tests of both groups. Bland-Altman Plot and Pearson correlation were used to examine the validity of 2-D and 3-D motion capture methods in evaluating knee valgus angle. Results: Two-dimensional knee FPPA and 3-D knee angle measured during 45° and 60° SLS in normal and excessive DKV groups showed moderate to excellent within-day and between-day reliability (ICC≥ 0.50). The current study showed that the 2-D knee frontal plane projection angle (FPPA) during 45° SLS were valid for the non-dominant leg in both groups. Additionally, the 2-D knee FPPA during 60° SLS were valid for non-dominant leg in excessive DKV group and dominant leg in normal group. Conclusion: Two-dimensional knee FPPA during 45° and 60° SLS also showed high within-and between-day reliability for both groups. The validity of 2-D knee FPPA during SLS depends on the squat depth, stance leg, and presence of DKV. Level of Evidence: 2B.

Development of Mobile App for Breast Examination Awareness Using Health Belief Model: A Qualitative Study.

BACKGROUND: Mobile health technologies are widely being used for delivering health behaviour interventions. However, there is insufficient evidence that they are integrating theory and only a few researchers utilized a qualitative approach in their study. OBJECTIVES: This paper aims to identify requirements in developing a breast examination awareness mobile app based on the component of the Health Belief Model (HBM) for integration in health promotion strategy. METHODS: A qualitative approach using semi-structured in-depth interview was utilized in this study. A purposive sampling method was conducted among public women attending hospital services, software and content experts in a tertiary teaching hospital in the East coast of Peninsular Malaysia. These interviews were recorded, transcribed and organized using NVIVO 11. The main themes were identified through thematic analysis of the interview transcripts.  Results: A total of 37 participants recruited in this study. The themes that emerged from the analysis are vulnerability, forecasting, reactive, influence, outcome and obstacles. The sub-themes findings supported the HBM's component in terms of the requirement for are an infographic risk factor, video (symptoms, self-examination), info (metastasis, survival, screening, triple assessment, treatment, myth and facts, benefit of early treatment, support groups), features (screening reminder, sharing button, prompt) and mobile app's design. CONCLUSION: The research findings could provide a guide for future app development from public women, content and software experts.  The information will be used to develop a breast examination awareness mobile app integrated with health theories.

Breast cancer therapy affects the expression of antineonatal Nav1.5 antibodies in the serum of patients with breast cancer.

Neonatal Nav1.5 (nNav1.5) is the alternative splice variant of Nav1.5 and it has been widely associated with the progression of breast cancer. The immunological context of nNav1.5 with respect to breast cancer metastases remains unexplored. The presence of antibodies against nNav1.5 may highlight the immunogenicity of nNav1.5. Hence, the aim of the present study was to detect the presence of antineonatal Nav1.5 antibodies (antinNav1.5-Ab) in the serum of patients with breast cancer and to elucidate the effects of breast cancer therapy on its expression. A total of 32 healthy female volunteers and 64 patients with breast cancer were randomly recruited into the present study as the control and breast cancer group, respectively. Patients with breast cancer were divided equally based on their pre- and ongoing-treatment status. Serum samples were tested with in-house indirect enzyme-linked immunosorbent assay (ELISA) to detect antinNav1.5-Ab, CD25 (T regulatory cell marker) using an ELISA kit and Luminex assay to detect the expression of metastasis-associated cytokines, such as vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-10, IL-8, chemokine (C-C motif) ligand 2 and tumor necrosis factor-alpha (TNF-α) The mean difference in the expression of antinNav1.5-Ab among the three groups (control, pretreatment and ongoing-treatment) was significant (P=0.0005) and the pretreatment breast cancer group exhibited the highest expression. The concentration of CD25 was highest in the pretreatment breast cancer group compared with the control and ongoing-treatment groups. There was a significant positive correlation between antinNav1.5-Ab and IL-6 in the pretreatment group (r=0.7260; P=0.0210) and a significant negative correlation between antinNav1.5-Ab and VEGF in the ongoing-treatment group (r=-0.842; P-value=0.0040). The high expression of antinNav1.5-Ab in the pretreatment group was in accordance with the uninterrupted presence of metastasis and highlighted the immunogenicity of nNav1.5 whereas the low expression of antinNav1.5-Ab in the ongoing-treatment group reflected the efficacy of breast cancer therapy in eliminating metastases. The augmented manifestation of T regulatory cells in the pretreatment group highlighted the functional role of nNav1.5 in promoting metastasis. The parallel expression of antinNav1.5-Ab with the imbalanced expression of cytokines promoting metastasis (IL-8, IL-6 and TNF-α) and cytokines that prevent metastasis (IL-10) indicated the role of nNav1.5 in breast cancer growth. The expression of antinNav1.5-Ab in accordance to the metastatic microenvironment indicates the immunogenicity of the protein and highlights the influence of breast cancer therapy on its expression level.

Violent crime datasets: Incidence and patterns in Malaysia from 2006 to 2017.

This article provides violent crime data in Malaysia from 2006 to 2017. The violent crimes include murder, rape, gang robbery, robbery and voluntarily causing hurt cases. A total of 330,395 violent crime cases were reported in this 12 year period and the data were tabulated state by state for all thirteen states of Malaysia, including two states in Borneo (Sabah and Sarawak) and one federal territory (Kuala Lumpur). In general, violent crimes show a decreasing trend from 2006 to 2017 in Malaysia. However, armed gang robbery and armed robbery show a fluctuating pattern from 2008 to 2011. A similar pattern was also recorded for unarmed gang robbery from 2008 to 2010. The violent crime data deposited here are available for further analysis, e.g., for identifying risk factors such as demography, lifestyle, socio-economic status, government policies etc. which may be associated with violent crime incidence and pattern across the country.

Validating the Press Ganey Questionnaire (Bahasa Melayu version).

PURPOSE: The purpose of this paper is to validate the Press Ganey Questionnaire (PGQ) (Bahasa Melayu version) using Hospital Universiti Sains Malaysia (HUSM) patients. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study comprised 252 patients visiting HUSM. Patients were selected using the convenience sampling method. The PGQ (Bahasa Melayu version) had three main factors: during your visit; your care provider and overall assessment. Data were analyzed using the structural equation modeling. FINDINGS: The exploratory factor analysis resulted in item reduction from 21 to 17, which contained four factors with eigenvalues greater than 1. Meanwhile, confirmatory factor analysis results showed that data fitted the model: χ2/df at 1.764, comparative fit index at 0.952, Tucker-Lewis index at 0.941 and root mean square error of approximation at 0.073. The average variance extracted value for the four factors was greater than 0.50, which indicated that PGQ convergent validity was met. Overall, PGQ produced good reliability with composite reliability score equals to 0.966. Four factors were reclassified as "during your registration," "hospital staff attitude," "doctor's attitude" and "overall assessment." RESEARCH LIMITATIONS/IMPLICATIONS: Patient satisfaction is an important and frequently used indicator for measuring healthcare quality; hence, a validated and reliable instrument is important for measuring patient satisfaction that leads to healthcare service quality assessment. PRACTICAL IMPLICATIONS: Validated PGQ provides some useful information for doctors, medical assistants, nurses and staff in the emergency department to help them become more prominent and efficient in their role as healthcare providers. SOCIAL IMPLICATIONS: Validated PGQ will help healthcare providers to deliver the best and exceptional care toward emergency patient, and thus improve their quality of work life. The findings in this study can be used as a guide or as baseline data for further research in this area. ORIGINALITY/VALUE: The PQG (Bahasa Melayu version) was confirmed as a reliable and valid instrument for measuring patient satisfaction. This research is the first PGQ validation study in Southeast Asia, specifically focusing on Malaysian respondents.