Media Systems for Education and Training in the Allied Health Sciences
Teoh Soon Teong, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya

Summary
The techniques involved in education and training are essentially techniques of communications of knowledge, skills and attitudes from one group of persons (teachers) to other groups (students). However complex the system of communication may be, the elements involved can be reduced conceptually to a simple model, the S-M-C-R-E model (Source-Message-Channel-Receiver-Effects). This shows the basic components of the process of communication. In each case, the process starts with a source having a messag to pass on to a receiver through a channel. Upon receipt of this message, the receiver responds and effects are generated accordingly. A feedback pathway is usually incorporated to allow the source to monitor the success or failure of his communication and also for the receiver to check upon the results of his reception of the message. In educational terms, the process would involve a teacher having a unit of instruction to transmit to a student through a delivery system. The student, upon receiving the unit of instruction, exhibits learning outcomes that can be assessed by relevant evaluation procedures. This generates feedback both for the teacher (in terms of how effective his "teaching" has been) and the student (how successful he has been in this "learning").

When this model is applied to the education and training of medical, para-medical and auxilliary health personnel, the link that may be explored further in the light of advances in media technology is the channel by which the unit of instruction is "transmitted" to the student. In educational terms, this is the delivery system.

The Early Detection of Unsuspected Carcinoma of Cervix in Malaysia by Exfoliative Cytological Screening
Prof T A Sinnathuray and Prof K S Lau, Departments of O & G and Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
The experiences of a cervical cancer screening programme at the University Hospital, University of Malaya, Malaysia, over a 5-year period since its inception, from March 1968 to February 1973, and covering a total of 11,283 obstetrical and gynaecological patients, that were screened by exfoliative vaginal and cervical smears, are presented.

The overall gross "pick-up" rate is 0.7%. The "pick-up" rate for all obstetrical patients (all ages) is very low - 0.2%. whereas that for all gynaecological patients (all ages) is high - 1.0%. There were no "pick-ups" in the women in the age-group "under 25 years", and the "pick-up" yield in the age-group of "25-29 years" was also very low - 0.2%. The "pick-up" yield was significantly high in the women over the age of 40 years - 1.4% to 1.8%. It is recommended that ideally all women who are aged 25 years and over, should have the benefits of a vaginal and cervical cytological cancer screening service.

A Review of Radiation Hazards with Special Reference to Diagnostic Radiology
A H Ang, Associate Professor and Head, Department of Radiology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
The risks from diagnostic radiology are small but it is wise to assume that any radiation, no matter how low the dose, is potentially harmful, especially in its possible genetic effects. Irradiation of the unborn foetus is particularly hazardous and should be avoided except in the presence of over-riding clinical indications. Although all reasonable precautions should be taken to see that patients are not unnecessarily irradiated, one should not forgo a radiological examination whenever this is judged after due consideration to be in the best interests of the patient.

Some Clinical Problems of a Psychiatric Day Centre
C L Teoh, T H Woon and S H S Sim, Department of Psychological Medicine, University of Malaya, Kuala Lumpur

Summary
Some clinicial problems related to a Psychiatric Day Centre are discussed. These problems include difficulty in getting suitable patients, dealing with the suicidal patient, the acting-out patient, the problem of dependency and the need for family involvement. Some aspects of their management are included.

Oral Carcinoma in the Chinese Female
K Ramanathan*, S Lakshimi**, *Consultant Dental Surgeon and Head, **Dental Officer, Division of Oral Medicine & Oral Pathology, Institute for Medical Research, Kuala Lumpur

Summary
Oral Cancer appears to the second commonest histologically confirmed malignant tumour in West Malaysia. The Chinese female has the lowest incidence of oral carcinoma (4.1%). The authors report on 36 Chinese female patients. The M:F ratio was 3.5:1. The peak incidence was between 50-69 years. The tongue (33.3%), buccal mucosa (22.9%), gingiva (14.6%) and palate (12.5%) were involved in descending order of frequency. In the tongue the anterior two-third was more commonly involved and the margins and dorsum were the commonest sites. Oral carcinoma presented clinically as : (1) an ulcer (2) an exophytic growth and (3) a swelling. It would appear desirable to consider carcinoma in the differential diagnosis of abscesses of the maxillary sulcus region in adults. Grade I carcinoma formed 60.0%, Grade II 25.7% and Grade III 14.3%. A comparison is made with oral cancer studies in China, Finland, US, South Africa and Australia.

Rapid Intravenous Inducted followed by Self-Applied Cricoid Pressure and Rapid Intubation
Robert P C Liew, Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
A combination of methods is described for rapid and safe intubation and is suitable for the anaesthetist working alone or without competent help. It is for the prevention of regurgitation during induction of anesthesia by a provision for rapid induction followed by self-applied cricoid pressure during the dangerous phase of 'going-under' up to the time just prior to largyngoscopy. Rapid laryngoscopy and intubation follows in the safe period. The author finds it suitable for use in obstetric anaesthesia and in other patients predisposed to regurgitation.

The factors predisposing to regurgitation are well described. These include food and fluid in the stomach or a distended stomach; incompetent cardia (e.g. hiatus hernia); presence of a gastric tube; intermittent positive pressure ventilation (a potent factor); raised intra-abdominal presure such as during suxamethonium fasciculations; lowered intra-oesophageal pressure such as active respiration during induction and respiratory obstruction; cough, and straining and hiccoughing; relaxation of the crico-pharyngeus muscle; light general anaesthesia; and hypotension which may provoke vomiting in twilight states.

Thus the patient, for emergency anaesthesia, unlikely to regurgitate is one who is well preoxygenated, rapidly and safely induced and rapidly and completely paralysed in the horizontal position and neck flexed. The technique described is suitable for the emergency anaesthetist working alone or without the assistance sometimes happening at night and weekends; and in district hospitals.

The Pattern of Bacteriological Cultures in a State Laboratory
Lim Swee Eng, Abdul Hamid bin Md Hussain, Institute for Medical Research, Perak Branch, Ipoh

Summary
The Perak Branch of the Institute for Medical Research at Ipoh serves as the Government Clinical Laboratory for all the 13 hospitals in the State of Perak. About a third of the specimens come from the Ipoh General Hospital, about 2 miles away, and the rest from other hospitals in the State, stretching from Parit Buntar in the north to Tanjong Malim in the south, about eighty miles away. IMR Ipoh is also the only place in Perak where bacteriological cultures are done for the hospitals in the State. The purpose of this paper is to survey the pattern of bacteriological isolates, the sensitivity pattern of the various pathogens and to identify the problems involved in running a bacteriological service for the State with hospitals upon to 80 miles away.

The Laboratory Diagnosis of Venereal Diseases I. Serological Tests for Syphilis
Dr M Jegathesan, Institute for Medical Research, Kuala Lumpur

Summary
The serological tests for detection of syphilis that are currently available have been reviewed. It is suggested that laboratories in this country utilise one non-treponemal test, the VDRL as a screening test and the FTA-ABS test as a confirmatory procedure.

A Practical Scheme for the Estimation of Serum Total Protein and Albumin
Kua See Lai, Chew Yin Lu, J E Buttery, G F de Witt, Division of Biochemistry, Institute for Medical Research, Kuala Lumpur

Summary
The Bromocresol Green (BCG) dye-binding method for serum albumin was found to be rapid and convenient. This method compares well with the electrophoresis method (r = 0.91) and the salt fractionation method (r = 0.96). A simplified scheme is proposed which allows for the rapid measurement of both albumin (BCG method) and total protein (Biuret method) together. This scheme is ideal for a busy clinical laboratory which has to cope with a large routine workload by manual methods.

Termination of Pregnancy by Single Large Dose Injection of Prostaglandins E2 and F2 Transcervically into the Extra-Amniotic Space
Allan Y H Ng, M Cheng, S S Ratnam

Summary
Twenty-six patients with gestations between 8 and 20 weeks were selected for termination of pregnancy by injection of large single doses of Prostaglandins E2 and F2 into the extra-amniotic space. PGE2 was used in 22 cases; 17 aborted. Of the 5 failures, 4 were not given larger doses because of the severity of side-effects (severe vomiting, headaches, rigors with high pyrexia and acute bronchospasm). PGF2 was used in 4 cases, 3 aborted after the 3rd dose of 20 mg. One case failed to abort after the third dose of 20 mg. Side-effects were noted in 3 cases. All the abortions were incomplete.

A Comparison of Trimethoprim-Sulphamethoxazole and Penicillin/Streptomycin in the Treatment of Gynaecological Infections
Wong Wai Ping, Ng Keng Hing, Chai Kim Hai, Department of O & G, University of Malaya, Kuala Lumpur

Summary
A controlled trial of the use of trimethoprim-sulphamethoxazole and penicillin and streptomycin in gynaecological infections was undertaken. 155 patients were treated in two randomly selected groups. Clinical responses were much better with trimethoprim-sulphamethoxazole in similar type of gynaecological infections. Significant responses were seen with septic abortions and post-operative gynaecological infections. (p > 0.02 < 0.05). For all groups, good responses were obtainable in 70% of cases treated with trimethoprim-sulphamethoxazole and 50% of cases treated with penicillin and streptomycin. The bacteriological studies correlated well with the clinical response. The invitro sensitivity was not significantly different. (p > 0.8 < 0.9). The side effects were minimal with both drug combinations.