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Archive for July, 2012

App on fasting for diabetics

PHARMACEUTICAL firm MSD has launched a mobile app called Ramadhan, Diabetes And Me to help diabetics manage their blood sugar levels while fasting.

Ewe (left) with diabetic patient Mohd Kamal Muda and Dr Nor Azmi showing the app and booklets

Its managing director, Ewe Kheng Huat, says the app is part of its Ramadan Hypoglycaemia campaign 2012. The company has also launched a booklet, Fact About Fasting, to create greater awareness about possible complications while fasting for diabetics.

The app offers tips and information about fasting and helps diabetics track their sugar level. The data stored is only available to the user who can later share it with doctors during consultations or save the information as a PDF file to be emailed.

The app also provides a Qiblat compass and times for prayers and breaking fast.

Both the app and booklet are available for free on AppStore and at Persatuan Diabetes Malaysia, clinics and hospitals.

For the video on a special interview with UKM Medical Centre head of endocrinology department Professor Dr Nor Azmi Kamaruddin on diabetes and how to use the Ramadhan, Diabetes And Me app, click on NST e-paper.

Read more: NST







Malaysia now big global player in healthcare industry: PM

KUALA LUMPUR — Datuk Seri Najib Razak said Malaysia is now a big global player in the healthcare industry following the dual public listing of IHH Healthcare Bhd on the Malaysia and Singapore stock exchanges.


“Malaysia is now a big global player in healthcare following the dual public listing of IHH Healthcare Bhd in M’sia & S’pore stock exchanges,” the Prime Minister said in his latest tweet today.

IHH, the healthcare arm of Malaysia’s state investor, Khazanah Nasional Bhd, was listed on Bursa Malaysia and the Singapore Exchange last Wednesday.

IHH’s assests include Turkish Hospital Group Acibadem AS, Singapore’s Parkway Holdings, India’s Apollo Hospitals Enterprise Ltd and Malaysia-based Pantai Hospitals and International Medical University (IMU).

It controls 83 hospitals in these countries, making it the world’s second largest hospital operator after Hospital Corporation of America (HCA), which runs 163 hospitals. — Bernama

Read more: NST

Good doctoring

Ensuring everyone gets good doctors.

ONE of the basic principles taught to all medical students and doctors is Primum non cere – first, do no harm. It is a reminder that an intervention can lead to harm to the patient, however well-intentioned it may be.

This principle is even more relevant today than in yesteryears.

Healthcare today is complex and more effective than before. However, according to the World Health Organization, the likelihood of harm is high, with a one in 300 chance of being harmed by healthcare compared to one in 1,000,000 chance of being harmed while in an aircraft.

The recent announcement that there is no limit to the number of attempts at the Medical Qualifying Examination raises fundamental questions about the quality of our doctors. Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?

Data from developed countries reveal that one in 10 hospitalised patients are harmed because of adverse events or errors. Similar data has been found in local studies.

The future of patients and their families depend on what doctors say and do. Imagine the good and harm that can result from doctors’ actions and inactions.

The media focus on housemen in recent years raises questions about the quality of medical education and training, as well as the challenges in ensuring that everyone gets good doctors, and by extension, the quality of healthcare patients will be receiving in the future.

Studying medicine

There are more applications for entry to medical schools worldwide. Many young people want to become doctors, whether of their own volition, at the behest of their parents, or for other reasons.

Until 2011, high academic qualifications were the sole criteria for admission to all public medical schools except University Science Malaysia (USM), which required an interview as well.

Since 2011, the Malaysian Medical Council’s (MMC) guidelines require all applicants to local medical schools to pass an interview to assess the applicant’s aptitude.

Although the minimum academic qualifications for entry into medical schools are prescribed by the MMC and the Malaysian Qualification Agency (MQA), there are still reports of non-compliance by some private medical schools. There are also reports that some private medical schools take in more students than permitted.

The situation in foreign medical schools is varied. Medical schools in advanced economies require high academic qualifications and aptitude assessments. However, some medical schools in some developing economies admit students whose academic results would not even qualify them to enter a Malaysian university for other courses which require lesser academic qualifications.

Many such students gain entry through the good offices of the agencies of these medical schools.

It is necessary to emphasise that selection for entry into medical school implies selection for the medical profession. Findings from studies worldwide confirm that although some students have achieved the academic qualifications required for entry into medical school, they are not suitable for a career in medicine.

It is in the interest of the public and such students that they should not gain admission, rather than to have to leave the course or the profession subsequently.

Feedback from some public local medical schools indicate that more than 50% of students do medicine because of parental or peer pressure, glamour, hope of financial rewards later, etc.

Can such students end up as good doctors?

Should the quality of students doing medicine be of concern to the public?

What should be done to those admitted to local or foreign medical schools without minimum academic qualifications?

The message to parents that good examination results do not make a career in medicine suitable for their progeny has to be repeatedly emphasised. There is nothing worse than getting into a profession that is unsuitable for one’s personality.

Medical schools

There are currently 34 medical schools for Malaysia’s population of 28 million, compared to nine and 12 medical schools in 2002 and 2007 respectively. Sixteen new medical programmes commenced in 2009 and 2010.

Data from the Avicenna Directory maintained by the University of Copenhagen, in collaboration with the World Health Organization and the World Federation for Medical Education (WFME), show that countries with similar populations like Australia (23 million), Saudi Arabia (28 million) and Canada (35 million) currently have 26, 16 and 16 medical schools respectively.

Our ASEAN neighbours, Indonesia, Singapore, Thailand and Philippines, with populations of 238 million, five million, 65 million and 92 million respectively have 35, two, 19 and 54 medical schools respectively.

Germany and the United Kingdom have 41 and 38 medical schools respectively for populations of 82 million and 62 million.

The issue is compounded by the fact that the government recognises more than 370 medical qualifications worldwide. This list was inherited from our colonial masters and has been added to over the years.

In addition, graduates from unrecognised medical schools can sit for the Medical Qualifying Examination (MQE) and, upon passing, will be registered by the MMC. The examination, which used to be the final year examination of the University of Malaya, National University of Malaysia and University Sains Malaysia, is now also conducted by 13 other universities.

The recent announcement that there is no limit to the number of attempts at the MQE raises fundamental questions about the quality of some of these doctors. Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?

In spite of the marked shortage of medical educators in Malaysia, the expansion of medical schools continued unabated in the past five years, thereby exacerbating the shortage. The majority of teaching staff in many medical schools are foreigners, some of whom do not speak any of the local languages, and some with no previous teaching experience.

It is not only the number, but also the quality of medical educators that is crucial in producing doctors that will make a positive impact on the public’s health. Medical educators are role models for students. It is well known that a deficient doctor is reflective of a deficient teacher; just as a child’s conduct is reflective of the parent’s.

Do the local medical schools take responsibility for the quality of their graduates? Are they responsive to societal needs and act proactively to meet those needs by addressing various issues that include selection criteria and admission policies; curricular improvements with emphasis on the concept of social accountability, medical ethics and human rights; and the quality and quality of medical educators?

Does the quality of medical education focus on the core educational needs of a doctor, providing him with the knowledge, attitude and skills necessary to address public health and clinical challenges?

Is this achievable when medical education is so much driven by the profit imperative?

What is the quality of medical education in recognised local and foreign medical schools, and how robust is its monitoring?

What is the role of agencies of foreign medical schools and how robust is their monitoring?


During the course of the newly graduated doctors’ future practice, there will be continuing advances in medical science and clinical practice, healthcare delivery and financing, increasing expectations of patients and the public, and changes in societal attitudes.

By itself, the basic knowledge and skills taught in medical schools is insufficient. The housemenship period is the time to start developing of the ingredients of the MMC’s “Good Medical Practice” ( Medical Practice_200412.pdf).

The young doctors have to learn to always put the interests of their patients first, and that the doctors’ professional practices affect the experiences of patients and their families. The skills of continuing professional development have to be developed so that their practices can advance in accordance to changes in medical knowledge and practices.

Prof TJ Danaraj, Foundation Dean of Medicine at the University of Malaya, wrote: “There is a worldwide acceptance of the views that the education of a physician extends over a lifetime, each stage resting upon the preceding one, and each preparing him for that which follows.”

Learning during housemenship is significantly experiential. There has to be sufficient quality teachers for this aspect of the young doctors’ training. The teachers, who are usually specialists, have a crucial role to play as they are role models for young doctors.

There has to be exposure to sufficient numbers of patients for young doctors to gain the experience required for independent practice. For example, they have to be exposed to the different ways in which the common conditions, appendicitis and urinary tract infections, present.

Failure to make an accurate diagnosis will lead to threats to life in the former, and long term consequences in the latter.

When there are few patients relative to the many housemen, it will, inevitably, have a negative impact on the latter’s training.

My classmates and I always remember our housemenship year. Some of our specialists were good teachers; some were less so. Some were excellent at expressing themselves verbally; others expressed their skills with their hands. Some did ward rounds before going home, and some even came back at night to do ward rounds.

We learnt from every specialist and from ourselves; what to do and what not to do in differing situations. Time was not a consideration. We finished our work before going home, whatever the time was.

There were instances when we would go to other wards or attend other specialists’ ward rounds, even after work, to learn from cases with interesting features. Those were not easy times. It was hard work, but our enthusiasm made the difference.

There were discussions and analyses which made us better doctors because we learnt from our specialists and ourselves. And, most importantly, we learnt how to learn.

The recent media report that “50% of housemen in Sabah can’t cope, need retraining” ( retraining) is worrying.

Equally disturbing are media reports of claims by housemen that they are overworked, training is minimal or absent and there is “bullying” by specialists.

There are also statements by specialists that some housemen work by the clock and that they do not even know the names of some housemen assigned to their wards and clinics “because there are so many of them”!

What is the quality of housemenship training and how robust is its monitoring? What is the quality of healthcare that patients can expect from the large numbers of housemen who need retraining?

What happens when they become Medical Officers after completing their housemenship? The possible long term effects on the quality of healthcare delivery in the country are indeed mind boggling!

Government agencies

It may interest the reader to know that several government agencies are involved in medical education. The Ministry of Higher Education (MOHE) controls all medical schools. It grants approval to establish a new medical school and through the Malaysian Qualification Agency (MQA), it requires all medical schools to comply with accreditation standards.

The hospitals of the Ministry of Health (MOH) and MOHE provide housemenship training and employment for Medical Officers upon its completion.

There are reports from some specialists that they find it increasingly difficult to cope with the dual tasks of providing care to patients and training housemen, with the former always having to take priority over the latter. Even the Ministry of International Trade and Industry (MITI) impact upon the health sector. There is linkage between goods and services in MITI’s trade negotiations with the World Trade Organization (WTO), ASEAN and other trading partners. The concessions permitting the presence of foreign ownership of private healthcare facilities and practising rights for foreign doctors in Malaysia will inevitably have an impact upon the quality of healthcare provided.

It is regrettable that there is no published national medical manpower planning policy. How many doctors does the country need, and by extension, how many medical schools?

Do the MOH and MOHE provide feedback to medical schools, regarding the skills, knowledge, attitudes and competency of their graduates? What is the quality of the feedback? Do the medical schools act on the feedback?

How many top notch foreign doctors will come to Malaysia to practise on a long term basis? What mechanisms are there in place to assess the quality of foreign doctors intending to practise here? Are there robust and valid assessment mechanisms in place?

Malaysian Medical Council

The MMC’s function is that of recognition of medical schools and professional regulation, based on its Code of Professional Conduct and its guidelines.

The local medical schools are given time-limited accreditation after assessments by teams comprising representatives from the MMC and MQA. However, it is impossible to accredit all the foreign medical schools recognised by the government because of manpower, logistic and financial reasons.

Most governments in developed economies acknowledge their limitations in assessing the quality of medical education. They require all those who want to practise medicine, particularly graduates from foreign universities, to pass a licensing examination.

Many Malaysian doctors who have practised abroad, particularly those above 40 years, have passed these licensing examinations without difficulty simply because of the quality of medical education they received.

Why is there no licensing examination when about half of the doctors commencing housemenship are graduates of foreign universities?

The number of disciplinary cases per 1,000 doctors dealt with by the MMC has increased in recent years. Although it is less than that of Singapore, the question as to whether the increase is due to the public’s increasing awareness of their rights, quality of care or both is not easy to determine.

Like all medical regulatory authorities worldwide, the MMC is addressing the issues of professionalism and performance measurement. This is of relevance as it is crucial to the enhancement of the trust of the public in individual doctors, in particular, and the medical profession, in general.

What this means

Many in the medical profession have stated publicly their concern that there is more emphasis on the quantity instead of the quality of medical graduates. The consequences in other areas of studies may not be significant, but in healthcare, it can be a matter of life and death for a patient or potential patient, which means all the population.

Healthcare delivery is so complex today that it is crucial to have doctors who put a premium on patient safety. If one has to make a choice, the public interest is better served by fewer good quality doctors than larger numbers who are deficient in their knowledge, skills or attitudes.

Society deserves nothing less.

Everyone, whether students, parents, medical schools, governmental agencies and the MMC, has a role to play in ensuring that everyone gets good doctors. However, the onus on medical schools, policymakers and regulators is paramount.

In concluding, everyone, particularly medical schools, policymakers and regulators, should be cognizant of the instructive statements of Hippocrates (460-377 BC), Avicenna (980 – 1037) and Sir William Osler (1849-1919). Hippocrates wrote, “Whenever a doctor cannot do good, he must be kept from doing harm”, and Avicenna “An ignorant doctor is the aide-de-camp of death.” Sir William Osler’s statement, “The best preparation for tomorrow is to do today’s work superbly well” is very apt for medical education and training.

The Star

Learn About Heart Disease with iHeart Touch – iPad App Review

If you’ve been diagnosed with heart disease, you’re probably scared, confused, and searching for more information.

Nucleus Medical Media has designed this iPad app, iHeart Touch, to assist doctors with patient education on both the diagnosis and progression of coronary artery disease, so it has all of the information you need on heart issues.

This free medical app opens with an interactive look at a beating heart, so it is definitely not an app for those of you who are squeamish.

The app then takes you through the arteries, displaying what a healthy artery looks like while explaining the function of the red blood cells. It is also interactive, so it instructs you to touch certain areas of the heart, and it then transforms to show you what an unhealthy artery looks like.

iHeart Touch then goes on to explain the various terms related to heart disease, such as atherosclerosis, which is where fatty deposits of plaque build up over the years.

The app visually takes you through all the stages of coronary artery disease, including treatments. While medication works during the early stages, later, sufferers will need an angioplasty, a stent, or even heart surgery.

After the app has run through its presentation, you can play it again or explore other areas of the app.

For medical professionals, which is who this app is designed for, you can add in your own drawings and explanations using the included pencil tool. For those of us who aren’t medical professionals, the app has some additional videos that can be watched by tapping the video button.

The videos are a bit complex, but it’s still worth watching, even without the supervision of a doctor, to understand the progression and the treatments of coronary artery disease.


There are videos on atherosclerosis, coronary angiography, CABG, coronary angioplasty, and the anatomy of the aorta. You can also access this information in PDF form, which can be emailed. This is great for doctors who need to send information to their patients.

Whether you’re a doctor, a medical student, someone suffering from heart disease, or simply interested in how the heart functions, this is a nicely designed app with clear graphics and explanations that’s well worth downloading.

What I liked: This is a super clear way of explaining coronary artery disease and understanding just what it is.

What I didn’t like: This app is clearly directed at medical professionals, but with a bit of extra information, it could be perfect for regular consumers as well.

To buy or not to buy: iHeart Touch is free, so if you’re interested in how the heart works, I’d highly suggest downloading this app and taking a look at it.

  • App Name: iHeart Touch
  • Version Reviewed: 1.0
  • Category: Medical
  • Developer: Nucleus Medical Media
  • Price: Free
  • Score: 


Argentine Grilled Chicken Recipe

By Christine Gallary

Argentine Grilled Chicken

The way chickens are butterflied and flattened for grilling in Latin America may seem a little funny: The result resembles a frog. But this method ensures quicker and more even cooking. Also, to achieve crispy, golden-brown skin and juicy meat, the chicken is cooked over indirect heat. This prevents flareups that can occur when fat drips directly onto the coals—flareups that would burn the outside of the chicken before the meat was cooked through.

What to buy: For true Argentine grilling, lump charcoal is essential, as it provides the smoky flavor that only comes from real wood. It can be found at most grocery and hardware stores.

Special equipment: A chimney starter makes lighting charcoal a snap. Place a wad of newspaper in the bottom, fill the top with charcoal, and light the newspaper. Using a chimney starter means there is no need for lighter fluid, which adds unpleasant chemical flavors to your wood. Charcoal chimney starters can be found at hardware stores or online.

You’ll need an instant-read thermometer to know when the chicken is done.

This recipe was featured as part of our Argentine Grilling menu.

  • 1/4 cup olive oil, plus more for oiling the grill
  • 4 medium garlic cloves, finely chopped
  • 1 tablespoon finely chopped rosemary leaves
  • Juice of 1 medium lemon
  • 1 (4- to 5-pound) chicken
  • Salt
  • Freshly ground black pepper
  • Argentine Chimichurri Sauce, for serving
  1. Place the measured oil, garlic, rosemary, and lemon juice in a small, nonreactive bowl and stir to combine; set aside.
  2. Remove the neck and any innards from the chicken and discard. Rinse the chicken inside and out with cold water and pat dry with paper towels.
  3. Place the chicken on a cutting board breast side up with the legs toward you. Gently pull one leg away from the body and, using a knife, slice through the skin between the leg and body to expose the thigh.

    Place your hand under the leg and push the thigh up toward you until you see the thigh joint pop out.

    Repeat with the other leg.

  4. Using kitchen shears, cut along the side of the breast through the ribs from the bottom cavity up toward the wing. Repeat on the other side.
    Open the chicken up by pulling the breasts up and away from you, then flip the chicken over.

    Press down firmly on the breastbone to flatten.

  5. Generously season the chicken all over with salt and pepper, then rub the reserved marinade all over. Transfer to a baking sheet and let sit at room temperature while you prepare the grill.
  6. Fill a medium-sized chimney starter with lump charcoal (about 5 to 6 quarts). Crumple 2 to 3 pages of newspaper and place them under the chimney starter. Set the starter on the charcoal grate of the grill. Light the newspaper. After about 10 minutes the coals should be red, with flames coming out of the top of the chimney starter. (If the charcoal doesn’t light, you may have put too much newspaper under the starter—the flames need air to spread—so repeat lighting the newspaper.) Place the lit charcoal on one side of the grill, forming a mound. Place the cooking grate over the charcoal and let the grill preheat, about 15 minutes (the charcoal should have turned white and ashy by this point).
  7. Rub the grill grate with a towel dipped in olive oil. Place the chicken skin side down on the half of the grill not over the coals, cover the grill, open both the bottom and top vents, and cook the chicken without moving it for 15 minutes. Rotate the chicken 180 degrees (making sure it is still not directly over the coals), cover, and grill until the skin of the chicken is crisp and browned all over, about 10 minutes more.
  8. Flip the chicken (two pairs of tongs are useful here), cover, and cook without moving for 15 minutes. Rotate the chicken 180 degrees, cover, and cook until the juices run clear and an instant-read thermometer registers 165°F when inserted into the thickest part of the thigh (make sure it’s not touching bone), about 10 to 15 minutes more.
  9. Transfer the chicken to a cutting board and let it rest for 10 minutes. Cut into 8 pieces and serve with chimichurri.

Beverage pairing: Weinert Carrascal Blanco, Argentina. Aged in concrete, this blend of Sauvignon Blanc and Chenin Blanc has assertive buttery and caramel-y flavors that stand up well to the smokiness of the chicken and the bold flavors in the chimichurri.


Black Jack Burger Recipe

Adapted from Hubert Keller with Penelope Wisner

Black Jack Burger

This cheeseburger recipe adapted from Hubert Keller of Burger Bar is made with juicy ground beef, Jack cheese, and olive tapenade. The rich, salty pungency of the olive paste adds complexity to the burger.

This recipe was featured as part of our guide to How to Grill (Almost) Everything.

  • 2 pounds ground chuck (15 to 20 percent fat content)
  • 2 tablespoons olive oil, plus more as needed
  • Kosher salt
  • Freshly ground black pepper
  • 4 slices (about 4 to 6 ounces) Monterey Jack cheese
  • 4 ciabatta buns or 4 slices ciabatta loaf, toasted
  • About 1/2 cup Tapenade
  • Butter lettuce (optional)
  • Thinly sliced ripe tomato (optional)
  1. Divide the meat into 4 portions and shape them into evenly sized patties. (Handle the meat gently to keep the texture light and the burger juicy.) The patties can be shaped, covered, and refrigerated overnight at this point.
  2. When ready to cook, heat the measured olive oil in a large frying pan or grill pan over medium-high heat until very hot. Alternatively, heat an outdoor grill to medium high (about 375°F to 425°F). Generously season the meat on both sides with salt and pepper.
  3. Cook the burgers, basting them with the fat in the pan using a large spoon and flipping halfway through the cooking time, about 7 to 10 minutes total for medium rare. (Do not press down on the patties while they are cooking.) For the last minute or two, drape a slice of cheese over each burger to melt. (You can also heat the oven to 450°F, cook the burgers on the stovetop until they are brown on both sides, and then finish them in the oven.)
  4. Remove the burgers to a platter, place in a warm spot, and let rest for several minutes before serving.
  5. To assemble the burgers, spread each of the bun bottoms with about a tablespoon of tapenade. Add the burgers, top with lettuce and tomatoes (if using), and another tablespoon of tapenade. Cover with the bun tops. Serve immediately.


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