ObjectiveTo determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.DesignPragmatic, randomized-controlled trial.SettingEmergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.ParticipantsIndividuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.InterventionIndividually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.Primary and secondary outcome measuresThe primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.ResultsTwo hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613–1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846–1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782–1.522)] and mortality rate [RR = 0.896 (95% CI 0.335–2.400)] did not differ between groups.ConclusionIndividually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.Trial registrationISRCTN Registry no. ISRCTN11674947

Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.

Background A barrier to gastrostomy feeding exists among Asian clinicians and caregivers due to negative perceptions regarding complications. We compared clinical and nutrition outcomes in older dysphagic Asian patients with nasogastric (NG) or gastrostomy tube feeding using a pragmatic study design. Methods The choice of enteral tube access was determined by managing clinicians and patients/caregivers. Comparisons of tube feeding methods were made during a 4‐month period, adjusting statistically for inherent confounders. Results A total of 102 participants (NG: n = 52, gastrostomy: n = 50) were recruited over 2 years from 2013 to 2015. Subjects on long‐term NG tube feeding were older (82.67 ± 7.15 years vs 76.88 ± 7.37 years; P < .001) but both groups had similar clinical indications (stroke: 63.5% NG vs 54% gastrostomy; P = .33). After adjustment for confounders, gastrostomy feeding was associated with fewer tube‐related complications (adjusted odds ratio [aOR] = 0.19; 95% confidence interval [CI] = 0.06–0.60) and better complication‐free survival rate (aOR = 0.32; 95% CI = 0.12–0.89) at 4‐month follow‐up. Anthropometric and biochemical nutrition parameters improved significantly in both groups at 4 months, but no significant differences were observed at the end of the study. Conclusion Gastrostomy feeding is associated with a greater 4‐month complication‐free survival and lower tube‐related complications compared with long‐term NG feeding in older Asians with dysphagia. However, no differences in nutrition outcomes were observed between NG and gastrostomy feeding at 4 months.

Objective This study aims to determine the psychometric properties of the Bahasa Malaysia (BM) version of the 6‐item De Jong Gierveld Loneliness Scale (DJGLS) among older adults in Malaysia. Methods A total of 200 participants aged 50 years and older completed the questionnaire in which 81 participants completed in BM. A subsample of 30 participants was retested after a period of 2 weeks. Results The DJGLS showed good internal consistency (Cronbach's alpha 0.71) and high test‐retest reliability (r = 0.93). Convergent validity was demonstrated by moderate positive correlation between total DJGLS loneliness score and UCLA loneliness scale (ULS‐8) (r = 0.56, n = 81, P < 0.001). Significant associations were found between loneliness and sex, ethnicity, geographic area and marital status. Conclusion The BM version of the 6‐item DJGLS is a reliable and valid loneliness measure for use among older adults in Malaysia.

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Healthcare education providers are eager to apply technologies in teaching and learning activities; however, students are the consumers in higher education, and their opinion and experience should be considered. We performed a meta-synthesis of qualitative studies to help inform our understanding of Southeast Asian healthcare students’ perceptions and experience of technology-based teaching and learning in their education. Our search strategy located 1599 articles from a dozen electronic research databases. Articles were analyzed for quality using the Hawker’s Evidence Appraisal Tool, and 23 qualitative studies were included in the final meta-synthesis. Technologies investigated largely involved online or blended learning, with fewer exploring virtual reality, simulations, telehealth, game-based learning, and videos. Three overarching themes were synthesized: (i) culture does matter in the implementation of technology-based learning; (ii) the values and limitations of technology used for learning; and (iii) technology is part of daily life and creates new challenges in education. Technology is an asset to enhance the learning experience, but educators must be aware of its limitations. Pre-coronavirus disease 2019 (COVID-19) studies were more focused on technology and product, and were optimistically reported, whereas COVID-19–spanning studies focused on life experience and paid more attention to reporting on the inherent challenges. The educational approaches, theories, cultural aspects, and availability of facilities all play a vital role in steering successful technology use in learning.

Background This study aims to analyse the effectiveness of distance learning during the COVID-19 pandemic among undergraduate health sciences students using systematic review. Online learning has been chosen as the best approach to continue offering education in this pandemic era. Method: The screening process was done using Scopus, ScienceDirect and PubMed based on the eligibility criteria. Out of 1486 studies, 1269 were screened. A total of 64 eligible studies obtained were included in the quantitative analysis. Results were categorized into i) student attitudes (perceptions/satisfactions/engagements), and ii) student learning outcomes, and compared to the Kirkpatrick model. Results Although facing difficulties, 50% of the studies was moderately satisfied with distance learning, while 36% was highly satisfied and 17% dissatisfied. Most studies (26%) reported flexibility in online learning. Internet issues (19%) and low interaction between learners and instructors (19%) were the most prevalent problems mentioned. Online education engages students better than traditional learning. The learning outcome was assessed using two categories: i) academic performance and ii) skill development. Most studies (72%) stated that online learning improves academic performance, 14% reported a drop, and 14% stated no effect, while an increase in clinical skills and communication skills were reported. Kirkpatrick evaluation revealed 80% of the studies obtained was evaluated at level 1 (reaction), 8% at level 2 (learning), 12% at level 3 (behaviour) and none at level 4 (results). Conclusion Overall, this systematic review found that the online learning performed better than expected during COVID-19, but the data gained is insufficient to say it is beneficial when compared to other types of teaching approaches.

Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between preclinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, Ireland Methods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used. Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students. Conclusion:Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.