The use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia.

BACKGROUND: The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak's inaugural multidisciplinary geriatric telemedicine service, TELEG. METHODS: This cross-sectional study took place at the Sarawak Heart Centre's geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG's utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants' acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson's correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5. RESULTS: Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n = 40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean = 4.9, SD = 0.65, on a scale of 1 to 6). Notably, care personnel concern (B = 0.256; p < 0.001) had the most significant impact on overall acceptance. CONCLUSION: This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users' experiences are crucial to further enhance acceptance.

What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies.

In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians' experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.

Training Characteristics, Personal Factors and Coping Strategies Associated with Burnout in Junior Doctors: A Multi-Center Study.

Physician burnout has been recognized as a public health crisis. However, there is a paucity of burnout studies in the context of medical internship. We assessed the prevalence and relationship between various training characteristics, personal variables, resilience, and coping with burnout in a cross-sectional study involving 837 interns from ten hospitals across Malaysian healthcare system. The instrument package included demographic questions, the Connor-Davidson Resilience Scale, Brief COPE and the Copenhagen Burnout Inventory. A total of 754 (90.1%) interns completed the inventories. We found a high prevalence of personal-related (73.3%), work-related (69.1%), and patient-related (43.4%) burnout among Malaysian interns. Multivariable analysis showed female gender (odds ratio (OR):1.50; 95% confidence interval (CI): 1.02-2.20), prior work experience (OR: 1.56; 95% CI: 1.05-2.30), and irregular spirituality routines (OR: 1.97; 95% CI: 1.30-2.99) were associated with increased odds of personal-related burnout. Irregular spirituality routines (OR: 2.24; 95% CI: 1.49-3.37) were associated with work-related burnout, while living with other people (OR: 1.77; 95% CI: 1.15-2.73) was associated with patient-related burnout. Lower resilience levels and avoidant copings were associated with personal-, work-, and patient-related burnout. Burnout prevalence among interns is high. The findings support the value of individual-targeted alongside organizational-targeted intervention in burnout reduction. As burnout is prevalent in both years of internship training, ongoing burnout prevention and wellbeing measures are deemed necessary.

Workforce Mobilization From the National Institutes of Health for the Ministry of Health Malaysia: A COVID-19 Pandemic Response.

The COVID-19 pandemic that emerged in 2019 has inflicted numerous clinical and public health challenges worldwide. It was declared a public health emergency by the World Health Organization and activated response teams at almost all Malaysian healthcare facilities. Upon activation of the National Crisis Preparedness and Response Center in January 2020, the National Institutes of Health Malaysia established a COVID-19 operation room at the facility level to address the rise in COVID-19 infection cases each day. The National Institutes of Health COVID-19 operation room committee formed a workforce mobilization team for an effective and efficient mobilization system to fulfill requests received for human resource aid within the Ministry of Health Malaysia facilities. Selected personnel would be screened for health and availability before mobilization letters and logistics arrangements if necessary. The workforce from the National Institutes of Health, consisting of various job positions, were mobilized every week, with each deployment cycle lasting 2 weeks. A total of 128 personnel from the six institutes under the National Institutes of Health were mobilized: tasks included fever screening, active case detection, health management at quarantine centers, and management of dead bodies. A well-organized data management system with a centralized online system integration could allow more rapid deployment and answer some of the key questions in managing a similar pandemic in the future. With improving infected COVID-19 cases throughout the country, the National Institutes of Health COVID-19 operation room was effectively closed on June 15, 2020, following approval from the Deputy Director-General of Health.

The prevalence of psychological distress and its association with coping strategies among medical interns in Malaysia: A national-level cross-sectional study.

INTRODUCTION: The prevalence of psychological distress is increasing worldwide. Stressful working environments and high expectations in medical practice put doctors at high risk of depression, anxiety, and stress, especially among medical interns. Effective coping strategies may reduce psychological distress in the clinical setting. This study aimed to determine the prevalence of psychological distress and its association with coping strategies among medical interns in Malaysia. METHOD: A total of 431 medical interns at 26 Malaysian Ministry of Health hospitals participated in this cross-sectional study in 2017. Self-administered questionnaires consisting of sociodemographic characteristics, items from DASS and BRIEF COPE were used. Descriptive analysis was done followed by further analysis with chi-square and Spearman correlation tests. RESULTS: The prevalence of stress, anxiety, and depression was 29.7%, 39.9%, and 26.2%, with a significantly higher prevalence among female and younger interns. Three-quarters of them (73.1%) applied problem-focused strategies as the main coping mechanism. Emotion-focused coping strategies showed a significant but weak correlation with anxiety and stress whereas avoidance-based coping strategies were significantly correlated with depression, anxiety, and stress. DISCUSSION: Medical internship is a highly grueling period. Besides emphasizing clinical competency, internship training should also impart the practice of healthy coping mechanisms. The vulnerable groups of females and younger interns should be taught positive coping skills so that they are empowered to handle any stressors on their personal and professional lives. Optimum psychological wellbeing of the medical interns can improve the overall work performance and quality of care for patients.

Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study.

BACKGROUND: Women of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers. METHODS: A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices. RESULTS: Average age was 29.61±4.71years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90±5.18kg. Mean postpartum weight retention was 3.12±4.76kg, 33.8% retaining ≥5kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention. CONCLUSION: Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.

Assessing the Extent of Adherence to the Recommended Antenatal Care Content in Malaysia: Room for Improvement.

BACKGROUND: Recent papers on monitoring of health services affirmed that while antenatal care (ANC) is an effective measure, quality is still a problem. Quality in maternal services "…involves providing a minimum level of care to all pregnant women…" Yet adherence to a minimum level of recommended ANC content appears to be unmet. Comprehensive review of ANC content rendered in environments with rapid changes in demographic, socio-economic, lifestyle and morbidity was sparse. Malaysia is such a country that has undergone these transitions with tremendous progress in health. However, recent progress in pregnancy outcomes is stagnating. This study aims to analyse adherence to recommended ANC; specifically, to examine the extent of adherence to recommended ANC content and to determine the factors influencing ANC content score. METHODS: A retrospective cohort study of 522 randomly selected women who used ANC was conducted. Data were extracted from individual records. The study examined adherence to essential ANC guidelines using weighted scoring for physical examination, health screening, case management, and health education. GLM Univariate analysis procedure was used to determine the factors associated with ANC content score. Binary logistic regression was used to assess ANC content level and pregnancy outcomes, controlled for ANC utilisation. RESULTS: Around half of the women had <80% of recommended ANC content documented. Health education had the lowest mean score, at around 35%. The low-risk pregnancies had a higher ANC content score than the high-risk pregnancies (78% vs. 75%; P = 0.002). The smallest clinics had a higher ANC content score than the bigger clinics (78% vs. 74-76%; P<0.001). ANC content score among the women with "adequate" ANC utilisation, as defined by the modified Adequacy of Prenatal Care Utilisation Index, was lower than the women with "adequate-plus" ANC utilisation (75% vs. 78%, P<0.001). Assessment of symphysis-fundal height, foetal presentation and foetal heart auscultation were initiated earlier than recommended. Inadequate ANC content was associated with higher prevalence of preterm birth. CONCLUSIONS: Our findings indicate the presence of issues related to delivery of recommended ANC content. We advocate for all pregnant women to be ensured of adherence to the recommended ANC content. We also recommend monitoring the delivery of health advice. Conforming to recommended timing of initiation for ANC practices is essential due to resource implication and possible implication on maternal wellbeing. The association of inadequate ANC content and preterm birth may be due to lesser opportunities to receive some of the care because of lower number of ANC visits among preterm birth; this may also indicate the importance of having adequate ANC content.