Journal of the Royal Medical and Dental Corps

Armed Forces Health Services Division in Supporting the Malaysian Armed Forces Readiness During COVID-19 Pandemic

Zulkeffeli Mat Jusoh — 2022-06-30

Since the Spanish flu pandemic, COVID-19 is by far the biggest communicable disease outbreak to have affected the world and our country1. As of April 2022, the pandemic has claimed over 35,000 Malaysian lives. Moreover, this pandemic has imposed a huge toll not only to individuals and communities but also has become a unique threat to our military readiness. In order to ensure the readiness of our forces, MAF Health Service (MAFHS) plays an important and crucial role to assure maximum readiness of the troops.

A Study of COVID-19 Mortality From Deployed Military Field Intensive Care Unit Supporting Penang Hospital: Risk Factors Analysis

Mohd Zamri Derahman — 2022-06-30

Introduction: The third wave of COVID-19 struck Malaysia in a tougher way. It was not only straining the health system but also carried a higher mortality rate. The phenomenon not only led to an influx of critically ill COVID-19 patients but also outstripped the number of Intensive Care Unit (ICU) beds available. Consequently, the first Field Intensive Care Unit was set up in the compound of Hospital Kepala Batas (HKB) in Penang, known as HKB Field ICU (HKB FICU). Objectives: This study would like to focus on the outcome of patients admitted to the field ICU, primarily describing the mortality rate and risk factors or comorbidities among non-survivors. Methods: This is a retrospective study. The details of the non-survivor hospital record, including the length of stay, and comorbidities were collated and examined to determine the key risk factors. Hypertension, Diabetes Mellitus, Obesity, Pregnancy, Cardiovascular events such as stroke and ischemic heart disease, vaccination status, and older age are among the risk variables investigated in this study. The study period was from May 28, 2021 until Dec 29, 2021. Results: Out of 421 patients, 40 were non-survivors, resulting in a mortality rate of 9.5% for the HKB FICU. The oldest non-survivor was 89 years old, and the youngest was 27 years old, with a mean age of 54.58 (SD=16.65). Males account for 67.5% of deaths (27 patients), while females account for 32.5%(13 patients). Most non-survivors (62.5 %) had two risk factors, 20% had three or more risk factors and 17.5% had at least 1 risk factor. Hypertension (42.5 %) and Diabetes Mellitus (42.5 %) were the most common risk factors among the non-survivors (40%).

Prevalence of Long COVID-19 Sequelae Among Malaysian Armed Forces Personnel – A Descriptive Introduction

Prathap Nair — 2022-06-30

Introduction: COVID-19 infection has taken on the world rampantly since December 2019 by a wave of catastrophe with global prevalence crossing 490 million cases and mortality reaching a count of 6 million deaths. Malaysian Armed Forces (MAF) military personnel were not spared from the pandemic and also contributed to the statistics. The aim of this study was to know the prevalence of long covid sequelae among military personnel and to describe the sociodemographic and employment characteristics of respondents. Methodology: This is a cross sectional study, which looks into prevalence of long COVID-19 sequelae or symptoms among MAF soldiers who were tested positive for COVID-19. Sampling method was convenience sampling. A self-administered questionnaire in Malay language was used to collect information needed. Results: As of December 2021, there were 10,061 MAF personnel tested positive for COVID-19. Among them a total of 3117 personnel (31%) participated in this research. The prevalence of long COVID-19 sequelae among them was 5.8% (n=181). Otherwise, 94.2% (n=2936) reported they have fully recovered from the disease without any morbidity. Conclusion: This study shows only a small percentage of MAF personnel are affected by long COVID-19 sequelae after 12 weeks of the initial COVID-19 diagnosis. More studies and statistical analysis is needed to determine the associations and predictors of long COVID-19 among MAF.

The Prevalence of Occupational Knee Injury Among Active Duty Royal Malaysian Army in Kuala Lumpur Camp

Nur Hidayah Shamsudin — 2022-06-30

Background: The members of the military are exposed to extreme occupational demands, requiring excellent physical and mental fitness. With frequent physical training, the military members are exposed to the risk of knee injury. Injuries among military personnel causing disability will negatively impact the capabilities of the armed forces. Methods: This is a cross- sectional study conducted among Royal Malaysian Army in a camp in Kuala Lumpur for 12 months using a self-reported questionnaire. 1244 respondents’ data were analysed in this report to determine the prevalence of occupational knee injury and the associated factors. Results: The prevalence of knee injury among respondents is 27.8% (95% CI: 25.4, 30.4), and the prevalence of occupational knee injury among the respondents is 16.6% (95% CI: 14.6, 18.8). Sports injury while on duty is the highest reported with 11%, followed by road traffic accidents (5.5%). Military drill (3.7%), sport’s activities while not on duty (3.5%), fall on duty (2.1%), fall out of duty (1%) and other causes of knee injury (1.4%). Age group, race, household income, troop element, service years, BMI, comorbidity were found to be significantly associated with the cause of knee injury, while rank, gender and education were not. Activities like jogging, cycling, football / futsal, gym or heavy weight lifting activities and other sports activities were also found to be significantly associated with the cause of injury. The factors contributing to occupational knee injuries were age 30 years old and above, BMI more than 25 kg/m2, and those who play football or futsal. Other types of sports and comorbidity were the factors that contribute to both occupational and non-occupational knee injury, while jogging and slow run were the protective factors for both.

Pre and Post Medical Deployment Experiences: A Qualitative Study

Mohammad Firdaus Yaacob — 2023-02-22

The Royal Medical and Dental Corps have served in a variety of medical deployments over the last fifty years, including battlefields, peacekeeping missions, and natural and man-made disasters, to provide the best care possible for the Malaysian Armed Forces, rescue disaster victims and refugees, and alleviate their sufferings. The healthcare professionals serving in military field hospitals encounter several hurdles during field operations that require mental and physical preparation, especially for first- timers. By sharing their invaluable prior experience, perhaps the military and other organisations will learn how to execute medical missions more effectively. This study was conducted to determine the pre- and post-medical deployment experiences of military healthcare professionals. Utilising face-to-face interviews, a qualitative study was conducted using a sample of twenty-one healthcare professionals who served in various field hospital deployments. To guarantee a varied population of informants, both purposeful and snowball sampling techniques were used. All interviews were transcribed from audio recordings and analysed for recurring issues and themes in the text, which were separately coded and validated by the researchers. Seven significant themes were highlighted. Four themes emerged for pre-medical deployment experiences: operational assessment and preparation, personal preparation (mental, medical skills, fitness and family readiness), force health protection (vaccination and medical check-up), and logistic preparation. Meanwhile, three themes emerged in terms of post-medical deployment experiences: operational withdrawal, force health protection (mental and physical check-up), and logistic withdrawal.

Prevalence of Hypertension and Its Risk Factors Among Malaysian Senior Military Officers

Zulkefley Mohammad — 2022-06-30

Introduction: Hypertension can have serious occupational implications for a military officer, especially for those who have specialised training and has become an essential asset to the organisation. Objective:The study aims to investigate the prevalence of hypertension among senior military officers of the Malaysian Armed Forces and determine the associated factors. We reviewed medical records of senior officers who underwent a routine medical examination at the Military Medicine Department, Kuala Lumpur Armed Forces Hospital from January 2018 to December 2018. Results: Out of 625 officers, the majority were from the army (61.2%), followed by the navy (19.8%) and air force (19.0%). The mean age of the officers was 47.4 (SD 6.3) years, and 94.1% were male officers. The prevalence of hypertension was 8.8% (55 officers). The results showed that hypertension was significantly associated with high BP (BMI) (p = 0.018), increased fasting blood sugar (FBS) (p < 0.001), high serum uric acid (p = 0.005), and elevated serum creatinine (p < 0.001). Moreover, none of the military factors, i.e. type of services, rank, and type of responsibility, were associated with hypertension. The ordinal logistic regression analysis showed that age [Odds ratio (OR) = 1.05], BMI (OR = 1.11), and elevated FBS (OR = 1.36) were significant predictors for the higher BP group. Conclusion: The prevalence of hypertension in the senior military officer is lower compared to the general population. However, the senior officers shared similar risk factors with the general population.

Disaster Management Zone (DMZ): Military Pharmacists Preparedness and Adaptation in COVID-19 Treatment Centre

Nurul Amirah Daud — 2022-06-30

The COVID-19 pandemic struck Malaysia in early 2020, cre- ating an unexpected public health emergency and straining medical facilities. The exponential growth of moderate to se- vere COVID 19 patients in healthcare centers in Klang Valley particularly, had become an enormous burden to the health care system. The Disaster Management Zone (DMZ) located in Tu- anku Mizan Armed Forces Hospital was activated to support the Greater Klang Valley Task Force (GKVTF) to cope with this sit- uation. Military pharmacists collaborated with other healthcare professionals to optimize the use and purchase of medications and consumables despite unforeseen challenges throughout the operation of the DMZ. Many lessons were learnt throughout this unforeseen experience, for example the need to explore digitali- zation of pharmacy management systems. This could be the best way forward as it reduces overall workload, minimizes medica- tion-related errors, and ultimately improves pharmaceutical care.

Effectiveness of an Educational Intervention Module to Increase Knowledge, Health Belief and Practices of Work- Related Injuries Among Healthcare Workers in the Malaysian Armed Forces

Ericsson Netto — 2022-06-30

Introduction: Statistics show that a hospital is one of the most hazardous places to work. Healthcare workers (HCW) in hospitals are exposed to physical, chemical, biological, ergonomics and psychosocial hazards that may cause serious injuries. Because there is widespread ignorance of the hazard, awareness must be increased about the harmful effects of injuries and about the prevention and control of WRI mainly through health behaviour changes. Objective: To develop, implement and evaluate the effectiveness of a Health Belief Model based educational intervention on WRI among healthcare workers. This program is expected to create awareness and enhance the knowledge in relation to practices of WRI and its prevention among the HCW. Materials and Methods: A clustered randomised controlled trial study was conducted in 2 military hospitals. All participants, who fulfilled the selection criteria, were recruited via stratified random sampling. The study instrument used was a self-administered questionnaire. Intervention group received an educational based intervention on WRI. The intervention and control groups were compared at 1 and 6-months post- baseline using RM-MANCOVA to determine the significant changes between and within groups using Statistical Package for the Social Sciences (SPSS), version 23.0. Result: There were statistically significant differences between intervention and control group on the combined dependent variables after controlling for covariates with F=79.679, p<0.001, Wilks’ Λ = 0.464, η2=0.536 and statistically significant differences within group subjects and time on the combined dependent variables after controlling for covariates with F=66.962, p<0.001, Wilks’ Λ = 0.337, η2=0.663. Discussion: The educational intervention delivered proved to be a success with a change in knowledge, health belief and practice during the 6 months’ period. Effect sustainability study must be followed up and education must be implemented to improve the occurrences of WRI among healthcare workers.

Challenges for Women Health-Care Workers During the COVID-19 Pandemic

Mohd Farid Md Yusof — 2022-06-30

Objective: Coronavirus disease (COVID-19) pandemic has spread globally. Malaysia is not spared from the impact of this health catastrophe; and has its own share of morbidity and mortality from the disease with the world population. As of 15th December 2020, Malaysia has recorded 86,618 cases of COVID-19 and had up to 422 deaths. Frontline healthcare workers (HCWs) faced a substantially higher risk of infection due to risk of COVID-19 exposure. In addition to that, juggling work and motherhood responsibilities is always a challenge for women healthcare workers. This case series illustrates some factors that contribute to the psychological distress of women HCWs during the pandemic.

Treating Non-Communicable Diseases (NCDs): Beyond Medication Prescription - A Case Series

Nurzeti Shaik Ahmad — 2022-06-30

Conventional care of NCDs primarily focuses on a biological approach via pharmacological intervention, often disregarding the patient’s needs. Not only has this contributed to an increased economic burden, adherence rate among patients and satisfaction rate among clinicians have also been abysmal. Most clinicians believe lifestyle and psychological approaches are impractical due to the time constraint in their busy clinics. This case series aims to examine the feasibility and preliminary efficacy of a patient centred model based on psychological approaches in managing patient with NCDs in a primary care setting. This write up is a case series involving 5 gentlemen with military background, ages between 34 to 66 years old with 2 to 5 NCD diagnosis. All cases were seen by a military family medicine specialist, trained in motivational interviewing. Patients were empowered to practice a healthy lifestyle and their challenges were addressed at every visit. The average duration of follow up was 20 months. Marked improvements were seen in fasting blood glucose, HbA1c level, blood pressure, triglycerides, high density lipoprotein, low density lipoprotein and alanine transaminase. All patients were able to reduce their weight and medication. Patients reported better quality of life and ability to sustain their healthier lifestyle change. This article hopes to explore the idea of de-prescribing as an essential effort in supporting lifestyle change.

Acute Management of Facial Cellulitis Secondary to Third Molar Infection

Tengku Natasha Eleena Tengku Ahmad Noor — 2022-06-30

We report a case of a 24-year-old male military personnel who showed up to the Emergency Department of Kem Terendak Armed Forces Hospital in a feverish condition complaining of having problems in eating due to a toothache and difficulty in opening the mouth for the past three days. After a thorough history and physical examination, we came up with a diagnosis of facial cellulitis secondary to infection of the third molar. This case was treated as an emergency due to the involvement of submandibular spaces. The patient was admitted and treated with incision and drainage together with removal of the third molar under general anesthesia. The patient was then discharged after 5 days of hospitalization. We hope sharing this case of infection of the third molar can educate more primary practitioners in its clinical care as poor management of cellulitis can lead to life-threatening conditions.

Optimizing Pharmaceutical Care For COVID-19 Patients: Pharmacist’s Intervention in Disaster Management Zone, Tuanku Mizan Armed Forces Hospital

Nurul Amirah Daud — 2022-06-30

The emergence of COVID-19 in Malaysia has led to the establishment of a Disaster Management Zone (DMZ) in Tuanku Mizan Armed Forces Hospital (TMAFH) by the Malaysian Armed Forces. Equipped with 250 beds, electrical supply, oxygen and vacuum ports and other medical support facilities, DMZ had become a full-fledged COVID-19 Category 4 and 5 ward in July 2021. During the operation of DMZ from 9 July 2021 to 27 August 2021, pharmacists were actively engaged in the daily operation of DMZ. A total of 129 prescription errors were identified and documented. Different types of prescribing errors and their frequencies detected were as follows: wrong frequency (31.8%), wrong dose (23.5%), wrong drug selection (18.6%), wrong duration (11.6%), missed dose (8.5%), polypharmacy (4.7%), drug interaction (0.8%) and wrong patient (0.8%). Interventions were done by pharmacists to address all these errors. This shows that pharmacists have an important role in optimizing pharmaceutical care for patients during a pandemic.