Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care.

A qualitative longitudinal study has become the preferred methodology for many researchers who are interested in documenting changes as the focus of analysis. Debates on appropriate qualitative longitudinal designs and methodological models are actively ongoing. The choice of methodological models to fit into a qualitative longitudinal design will depend on the objectives of the study. Many researchers have also reported on the use of qualitative longitudinal study, in particular on the challenges in study design, data collection, and data analysis. In the researcher’s review of the relevant literature, however, the researcher was unable to locate the use of a qualitative longitudinal methodology to study the same phenomenon comparatively across two countries on different continents. This article, therefore, adds to the current understanding of qualitative longitudinal study through the discussion of methods and recommendations for conducting a comparative qualitative longitudinal study across two countries on different continents. This article discusses the research methodological challenges and recommendations, as well as lessons learned, upon completion of a doctoral study in 2016. As not many researchers have undertaken a comparative qualitative longitudinal approach in a doctoral study, it is worth sharing with researchers who are planning a similar methodology what they could expect and should be prepared for.

Malaysian government started the Movement Control Order (MCO) on 18th March 2020, as one of the initiatives to prevent the more massive outbreak of COVID-19. Recent statistics showed a rapid rise in the numbers of positive COVID-19 patients. However, the statistics on COVID-19 patients being discharged showed that the higher authority was very committed in managing COVID-19 crisis. This online study was conducted among 1,543 Malaysian adults using a validated questionnaire to explore more findings on the Malaysian’s Knowledge, Attitude and Practice (KAP) level towards COVID-19 prevention during the MCO period. Descriptive study and binary logistic regression were performed using SPSS version 22. This study showed that the majority of respondents have good KAP level regarding COVID-19 prevention. WhatsApp and Telegram were the primary sources of information used by the respondents. Education level was the main predictor for knowledge (OR: 2.083, CI: 1.605-2.702), attitude (OR:1.854, Ci; 1.42-2.42) and practice (OR: 1.745, CI; 1.326-2.096) regarding COVID-19 prevention (p<0.001). Knowledge (OR; 1.636, CI: 1.302-2.054) and practice (OR;2.328, CI: 1.858-2.916) were predictors of attitude regarding COVID-19 prevention (p<0.001). In conclusion, total adherence to the Movement Control Order (MCO) along with public health interventions focusing on behavioral change may play vital roles in breaking the chain of infection.

This study was designed to develop an evaluation tool for assessing professional behavior and clinical competencies from the graduates' perspective. Methods: This study employed mixed method in a sequential exploratory design. The semi-structured interviews were conducted with three graduates from different cohorts. The qualitative analysis of the interviews found six emerging themes for professional behavior and clinical competencies development. These themes were then developed into a 55-item questionnaire. The questionnaire was then distributed to 84 medical graduates for exploratory factor analysis (EFA) from February to April 2019. The quantitative data were analyzed using IBM SPSS ver. 21.0 (IBM Corp., Armonk, USA) for principal axis factoring. After conducting EFA, we proceeded with confirmatory factor analysis (CFA) with another 120 graduates to validate the tool. Results: Eighty-four graduates completed the questionnaire for EFA. Upon completion of EFA, 35 out of 55 items of the questionnaire were found to be valid and reliable. The most appropriate fit was seven factors, which explained 58.18% of variance between them after 15 iterations with Cronbach's α of 0.916. The personal satisfaction factor was noted to be weak. It was therefore added to patient management factor due to its similar intention. The final EFA factor after the modification was six. The CFA found that 34 out of 35 items was valid and reliable that representation of the latent variables. Conclusion: The questionnaire has achieved the desired construct validity score and can be used as an evaluation tool to assess professional behavior and clinical competencies from the graduates' perspective.

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