Coronavirus disease 2019 (COVID-19) has become a global health threat and has placed an extraordinary demand on healthcare workers around the world. In this study, we aim to examine the prevalence of burnout and its associated factors and experience among Malaysian healthcare workers during the COVID-19 pandemic through an embedded mixed-method study design. We found that more than half of Malaysian healthcare workers in this sample experienced burnout. Direct involvement in COVID-19 screening or treatment, having a medical condition, and less psychological support in the workplace emerged to be the significant factors in personal-, work-, and patient-related burnout. Participants described their workloads, uncertainties caused by the pandemic, challenging work–family balance, and stretched workplace relationships as the sources of burnout. Exhaustion appeared to be the major symptom, and many participants utilized problem-focused coping to deal with the adversities experienced during the pandemic. Participants reported physical-, occupational-, psychological-, and social-related negative impacts resulting from burnout. As the pandemic trajectory is yet unknown, these findings provide early insight and guidance for possible interventions.

When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness. Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world. However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic. COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.

BackgroundMaternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. Our study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia.MethodsA qualitative phenomenological approach with in-depth interview method was conducted in two tertiary hospitals in Kelantan, Malaysia. All women admitted to labour room, obstetrics and gynaecology wards and intensive care units in 2014 were screened for the presence of any vital organ dysfunction or failure based on the World Health Organization criteria for maternal near miss. Pregnancy irrespective of the gestational age was included. Women younger than 18 years old, with psychiatric disorder and beyond 42 days of childbirth were excluded.ResultsThirty women who had experienced maternal near miss events were included in the analysis. All were Malays between the ages of 22 and 45. Almost all women (93.3%) had secondary and tertiary education and 63.3% were employed. The women’s perceptions of the quality of their care were influenced by the competency and promptness in the provision of care, interpersonal communication, information-sharing and the quality of physical resources. The predisposition to seek healthcare was influenced by costs, self-attitude and beliefs.ConclusionsSelf-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women’s perceptions of quality of care should be of concern to those seeking to improve services at healthcare facilities. The addition of a maternal near miss case review programme, allows for understanding on the factors related to providing care or to the predisposition to seek care; if addressed, may improve future healthcare and patient outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1377-6) contains supplementary material, which is available to authorized users.

Objective. To study the retinal nerve fibre layer (RNFL) thickness and visual electrophysiology testing in patients with Alzheimer’s disease (AD). Methods. A cross-sectional, hospital-based study: 25 AD subjects and 25 controls were recruited. Candidates who fulfil the criteria with normal ocular examinations were made to proceed with scanning laser polarimetry, pattern electroretinogram (PERG), and pattern visual evoked potential (PVEP) examinations of the right eye. RNFL thickness, PERG, and PVEP readings were evaluated. Results. In AD, the mean of average RNFL thickness was 45.28 μm, SD = 3.61, P<0.001 (P<0.05), while the superior RNFL thickness was 54.44 μm, SD = 2.85, P<0.001 (P<0.05) and inferior RNFL thickness was 47.11 μm, SD = 4.52, P<0.001 (P<0.05). For PERG, the mean P50 latency was 63.88 ms, SD = 7.94, P<0.001 (P<0.05) and the mean amplitudes of P50 waves were 1.79 μV, SD = 0.64, P<0.001 (P<0.05) and N95 waves were 2.43 μV, SD = 0.90, P<0.001 (P<0.05). For PVEP, the mean latency of P100 was 119.00 ms, SD = 9.07, P<0.001 (P<0.05), while the mean latency of N135 was 145.20 ms, SD = 8.53, P<0.001 (P<0.05). The mean amplitude of P100 waves was 3.71 μV, SD = 1.60, P<0.001 (P<0.05), whereas the mean amplitude of N135 waves was 3.67 μV, SD = 2.02, P<0.001 (P<0.05). RNFL thickness strongly correlates with PERG readings, with P50 latency R = 0.582, R2 = 0.339, P=0.002 (P<0.05), amplitude of P50 wave at R = 0.749, R2 = 0.561, P≤0.001 (P<0.05), and amplitude of N95 wave at R = 0.500, R2 = 0.250, P=0.011 (P<0.05). No significant difference and correlation were observed on PVEP readings. Conclusion. The mean of the average, superior and inferior RNFL thickness were significantly lower in the AD group compared with control. There is also significant difference of PERG and PVEP parameters between AD and controls. Regression analysis showed average RNFL thickness having significantly linear relationship with the PERG parameters.

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