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Shift schedule realignment and patient safety culture

Wijaya MI, Mohamad AR, Hafizurrachman M

Int J Health Care Qual Assur, 2020 Jan 15;ahead-of-print(ahead-of-print).
PMID: 32012498 DOI: 10.1108/IJHCQA-04-2019-0080

PURPOSE: The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture.
DESIGN/METHODOLOGY/APPROACH: Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.
FINDINGS: Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 - 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 - 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 - 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 - 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 - 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 - 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 - 1.818; p<0.001).
PRACTICAL IMPLICATIONS: With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.
ORIGINALITY/VALUE: Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.
Fulltext Serum bone specific alkaline phosphatase and urinary deoxypyridinoline in postmenopausal osteoporosis

Nawawi HM, Yazid TN, Ismail NM, Mohamad AR, Nirwana SI, Khalid BA

Malays J Pathol, 2001 Dec;23(2):79-88.
PMID: 12166596

The objectives of this study were to: (i) evaluate the diagnostic sensitivity and specificity of the biochemical bone markers: serum total alkaline phosphatase (TALP), bone specific alkaline phosphatase (BSALP) and urinary deoxypyridinoline (Dpyr) in postmenopausal osteoporosis, (ii) compare the bone turnover of postmenopausal osteoporotic patients without and with hormone replacement therapy (HRT) against controls and (iii) identify the correlation between these bone markers and bone mineral density (BMD). We examined 42 postmenopausal women with BMD proven osteoporosis and 35 control subjects. Serum TALP, BSALP and urinary Dpyr were measured. All three biochemical bone markers showed comparable moderate diagnostic sensitivity but Dpyr had the highest diagnostic specificity. There were significantly higher serum TALP, BSALP and urinary Dpyr levels in non-HRT treated patients compared to controls (p<0.005, <0.0001 and <0.005 respectively). There were no significant differences in the levels of all three bone markers between HRT treated patients and control subjects. There was no significant correlation between TALP, BSALP or Dpyr and BMD in both controls and patients. In conclusion, the biochemical bone markers are not useful in diagnosis of postmenopausal osteoporosis but may have a role in monitoring progress and response to treatment. HRT treatment reduces bone turnover of postmenopausal osteoporosis.
Fulltext Progressive supra-axial cervical instability in Down syndrome: a case report emphasising the role of extended short-segment fusion

Tan GH, Tan KK, Afian MS, Liew WF, Mohamad AR

Med J Malaysia, 2005 Jul;60 Suppl C:111-3.
PMID: 16381295

We report a case of upper cervical instability associated with Down syndrome to highlight its potential progression to inflict cord compression and the rationale for surgical decompression and extended short segment occipito-axial fusion.
Intracranial suppuration caused by Micrococcus luteus

Selladurai BM, Sivakumaran S, Aiyar S, Mohamad AR

Br J Neurosurg, 1993;7(2):205-7.
PMID: 8098607

Micrococcus spp. are commensal organisms colonizing the body surfaces of humans. In a few instances these organisms have been reported to colonize ventricular shunts. We report a patient, with no overt evidence of immunosuppression, in whom Micrococcus luteus was responsible for intracranial suppuration at multiple sites.
Improving patient satisfaction: the virtual breakthrough series collaborative

Wijaya MI, Mohamad AR, Hafizurrachman M

Int J Health Care Qual Assur, 2019 Feb 11;32(1):296-306.
PMID: 30859877 DOI: 10.1108/IJHCQA-01-2018-0014

PURPOSE: The purpose of this paper is to improve the Siloam Hospitals' (SHs) patient satisfaction index (PSI) and overcome Indonesia's geographical barriers.
DESIGN/METHODOLOGY/APPROACH: The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.
FINDINGS: The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.
RESEARCH LIMITATIONS/IMPLICATIONS: The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.
PRACTICAL IMPLICATIONS: The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.
ORIGINALITY/VALUE: The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.
Fulltext Ants (Hymenoptera: Formicidae) associated with pig carcasses in Malaysia

Heo CC, Mohamad AR, Rosli H, Nurul Ashikin A, Chen CD, John J, et al.

Trop Biomed, 2009 Apr;26(1):106-9.
PMID: 19696735

An observational study was conducted in an oil palm plantation in Tanjung Sepat, Selangor, Malaysia on August until September 2007 to note the decomposition process of pigs and their related faunal succession. We collected six species of ants (Formicidae) from 3 subfamilies: Formicinae (Oecophylla smaragdina and Anoplolepis gracilipes), Myrmicinae (Tetramorium sp. and Pheidologeton sp.) and Ponerinae (Odontoponera sp. and Diacamma sp.) that were associated with pig carcasses placed on the ground. Oecophylla smaragdina, Pheidologeton sp. and Tetramorium sp. were found on a partially burnt pig carcass whereas the other species were recovered from unburned pig carcass. These ants predated on fly eggs, larvae, pupae and adults. Ants could be found at all stages of decomposition starting from fresh until dry stage. Predatory ants can reduce fly population and thus may affect the rate of carcass decomposition but this was not seen in our study. Even though O. smaragdina was seen at all stages of decomposition of the burnt pig, this did not alter much the decomposition process by fly larvae.