Displaying publications 1 - 20 of 98 in total

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  1. Latiff LA, Ibrahim Z, Pei CP, Rahman SA, Akhtari-Zavare M
    Asian Pac J Cancer Prev, 2015;16(18):8495-501.
    PMID: 26745108
    PURPOSE: This study was conducted to assess the agreement and differences between cervical self-sampling with a Kato device (KSSD) and gynecologist sampling for Pap cytology and human papillomavirus DNA (HPV DNA) detection.

    MATERIALS AND METHODS: Women underwent self-sampling followed by gynecologist sampling during screening at two primary health clinics. Pap cytology of cervical specimens was evaluated for specimen adequacy, presence of endocervical cells or transformation zone cells and cytological interpretation for cells abnormalities. Cervical specimens were also extracted and tested for HPV DNA detection. Positive HPV smears underwent gene sequencing and HPV genotyping by referring to the online NCBI gene bank. Results were compared between samplings by Kappa agreement and McNemar test.

    RESULTS: For Pap specimen adequacy, KSSD showed 100% agreement with gynecologist sampling but had only 32.3% agreement for presence of endocervical cells. Both sampling showed 100% agreement with only 1 case detected HSIL favouring CIN2 for cytology result. HPV DNA detection showed 86.2%agreement (K=0.64, 95% CI 0.524-0.756, p=0.001) between samplings. KSSD and gynaecologist sampling identified high risk HPV in 17.3% and 23.9% respectively (p= 0.014).

    CONCLUSION: The self-sampling using Kato device can serve as a tool in Pap cytology and HPV DNA detection in low resource settings in Malaysia. Self-sampling devices such as KSSD can be used as an alternative technique to gynaecologist sampling for cervical cancer screening among rural populations in Malaysia.

    Matched MeSH terms: Health Resources
  2. Huo Y, Lee SW, Sawhney JP, Kim HS, Krittayaphong R, Nhan VT, et al.
    Clin Cardiol, 2015 Sep;38(9):511-9.
    PMID: 26206158 DOI: 10.1002/clc.22431
    BACKGROUND: In-hospital and postdischarge mortality for acute coronary syndromes (ACS) vary across Asia and remain generally poorer than globally. The relationship between real-life antithrombotic management patterns (AMPs) and ACS-related outcomes in Asia is unclear.

    METHODS: EPICOR Asia (Long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) (NCT01361386) is a prospective, multinational, observational study of patients discharged after hospitalization for an ACS, with 2-year follow-up. The aim is to describe short- and long-term (up to 2 years post-index event) AMPs in patients hospitalized for ACS and to record clinical outcomes, healthcare resource use, and self-reported health status. Pre- and in-hospital management, AMPs, and associated outcomes, with particular focus on ischemic and bleeding events, will be recorded during the 2-year follow up.

    RESULTS: Between June 2011 and May 2012, 13 005 patients were enrolled. From these, 12 922 patients surviving an ACS (6616 with STEMI, 2570 with NSTEMI, and 3736 with UA) were eligible for inclusion from 219 hospitals across 8 countries and regions in Asia: China (n = 8214), Hong Kong (n = 177), India (n = 2468), Malaysia (n = 100), Singapore (n = 93), South Korea (n = 705), Thailand (n = 957), and Vietnam (n = 208).

    CONCLUSIONS: EPICOR Asia will provide information regarding clinical management and AMPs for ACS patients in Asia. Impact of AMPs on clinical outcomes, healthcare resource use, and self-reported health status both during hospitalization and up to 2 years after discharge will also be described.

    Matched MeSH terms: Health Resources/statistics & numerical data
  3. Mikton C, Power M, Raleva M, Makoae M, Al Eissa M, Cheah I, et al.
    Child Abuse Negl, 2013 Dec;37(12):1237-51.
    PMID: 23962585 DOI: 10.1016/j.chiabu.2013.07.009
    This study aimed to systematically assess the readiness of five countries - Brazil, the Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa - to implement evidence-based child maltreatment prevention programs on a large scale. To this end, it applied a recently developed method called Readiness Assessment for the Prevention of Child Maltreatment based on two parallel 100-item instruments. The first measures the knowledge, attitudes, and beliefs concerning child maltreatment prevention of key informants; the second, completed by child maltreatment prevention experts using all available data in the country, produces a more objective assessment readiness. The instruments cover all of the main aspects of readiness including, for instance, availability of scientific data on the problem, legislation and policies, will to address the problem, and material resources. Key informant scores ranged from 31.2 (Brazil) to 45.8/100 (the Former Yugoslav Republic of Macedonia) and expert scores, from 35.2 (Brazil) to 56/100 (Malaysia). Major gaps identified in almost all countries included a lack of professionals with the skills, knowledge, and expertise to implement evidence-based child maltreatment programs and of institutions to train them; inadequate funding, infrastructure, and equipment; extreme rarity of outcome evaluations of prevention programs; and lack of national prevalence surveys of child maltreatment. In sum, the five countries are in a low to moderate state of readiness to implement evidence-based child maltreatment prevention programs on a large scale. Such an assessment of readiness - the first of its kind - allows gaps to be identified and then addressed to increase the likelihood of program success.
    Matched MeSH terms: Health Resources
  4. Norhayati MN, Nik Hazlina NH, Asrenee AR, Sulaiman Z
    BMC Pregnancy Childbirth, 2017 Jun 15;17(1):189.
    PMID: 28619038 DOI: 10.1186/s12884-017-1377-6
    BACKGROUND: Maternal 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.

    METHODS: A 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.

    RESULTS: Thirty 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.

    CONCLUSIONS: Self-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.

    Matched MeSH terms: Health Resources
  5. Leung D, Chua GT, Mondragon AV, Zhong Y, Nguyen-Ngoc-Quynh L, Imai K, et al.
    Front Immunol, 2020;11:1605.
    PMID: 32903579 DOI: 10.3389/fimmu.2020.01605
    Background: The Asia Pacific Society for Immunodeficiencies (APSID) conducted nine primary immunodeficiency (PID) Schools in 5 years since inauguration to provide PID care training for early career physicians in Asia Pacific, a region with divergent needs in PID resources and training. Objective: To identify differences in PID patient care resource and training needs across Asia Pacific and propose a corresponding action plan. Methods: The Human Development Index (HDI) indicates the degree of socio-economic development in each country/region. Information related to investigations and learning issues were extracted from the abstracts and personal statements from all Schools and mapped onto resource and training needs. Correlations between HDI and country/region-specific parameters were tested by two-tailed Pearson correlation. Results: A total of 427 abstracts were received in nine Schools between 2015 and 2020, predominantly on immunodeficiencies affecting cellular and humoral immunity. Genetic confirmation was described in 61.8% of abstracts, and its absence negatively correlated with HDI (r = -0.696, p = 0.004). Essential immunologic and genetic tests were not available in 25.4 and 29.5% of abstracts, respectively, and their absence negatively correlated with HDI (r = -0.788, p < 0.001; r = -0.739, p = 0.002). HDI positively correlated with average testing level (r = 0.742, p = 0.002). Cases from medium-HDI countries/regions focused on learning how to investigate a patient for PIDs in cases of severe or atypical infections, whereas those from very-high-HDI countries/regions, from which most faculty members originated, listed hematopoietic stem cell transplantation and gene therapy, newborn screening, and research as learning issues more frequently. Conclusion: There are unique HDI-related PID resource and training needs in each country/region. APSID proposes HDI group-specific strategies to improve PID care and education in her member countries/regions. Further quantitative analysis of needs in PID care in Asia Pacific is needed for lobbying governments to increase their support for PID care and research.
    Matched MeSH terms: Health Resources
  6. Ayob Y
    Biologicals, 2010 Jan;38(1):91-6.
    PMID: 20133151 DOI: 10.1016/j.biologicals.2009.10.002
    Hemovigilance like quality systems and audits has become an integral part of the Blood Transfusion Service (BTS) in the developed world and has contributed greatly to the development of the blood service. However developing countries are still grappling with donor recruitment and efforts towards sufficiency and safety of the blood supply. In these countries the BTS is generally fragmented and a national hemovigilance program would be difficult to implement. However a few developing countries have an effective and sustainable blood program that can deliver equitable, safe and sufficient blood supply to the nation. Different models of hemovigilance program have been introduced with variable success. There are deficiencies but the data collected provided important information that can be presented to the health authorities for effective interventions. Hemovigilance program modeled from developed countries require expertise and resources that are not available in many developing countries. Whatever resources that are available should be utilized to correct deficiencies that are already apparent and obvious. Besides there are other tools that can be used to monitor the blood program in the developing countries depending on the need and the resources available. More importantly the data collected should be accurate and are used and taken into consideration in formulating guidelines, standards and policies and to affect appropriate interventions. Any surveillance program should be introduced in a stepwise manner as the blood transfusion service develops.
    Matched MeSH terms: Health Resources/supply & distribution
  7. Mahadeva S, Chia YC, Vinothini A, Mohazmi M, Goh KL
    Gut, 2008 Sep;57(9):1214-20.
    PMID: 18441005 DOI: 10.1136/gut.2007.147728
    To compare a Helicobacter pylori "test and treat" strategy with prompt endoscopy in young Asians with dyspepsia.
    Matched MeSH terms: Health Resources/utilization
  8. Leddin D, Armstrong D, Raja Ali RA, Barkun A, Butt AS, Chen Y, et al.
    J Clin Gastroenterol, 2020 9 11;54(10):833-840.
    PMID: 32909973 DOI: 10.1097/MCG.0000000000001411
    Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.
    Matched MeSH terms: Health Resources/economics*
  9. Taib NA, Yip CH, Ibrahim M, Ng CJ, Farizah H
    Asian Pac J Cancer Prev, 2007 Jan-Mar;8(1):141-5.
    PMID: 17477791
    The message that health care providers caring for patients with breast cancer would like to put forth, is that, not only early detection is crucial but early treatment too is important in ensuring survival. This paper examines the pattern of presentation at a single institution over a 10-year period from 1995 to 2005. In Malaysia, education outreach programmes are ongoing, with contributions not only from the public sector, but also private enterprise. Articles on breast cancer in local newspapers and women magazines and television are quite commonplace. However are our women getting the right message? Now is an appropriate time to bring the stakeholders together to formulate a way to reach all women in Malaysia, not excluding the fact that we are from different races, different education levels and backgrounds requiring differing ways of delivering health promotion messages. To answer the question of why women present late, we prospectively studied 25 women who presented with locally advanced disease. A quantitative, quasi-qualitative study was embarked upon, as a prelude to a more detailed study. Reasons for presenting late were recorded. We also looked at the pattern of presentation of breast lumps in women to our breast clinic in UMMC and in the surgical clinic in Hospital Kota Bharu, in the smaller capital of the state of Kelantan, in 2003. There is hope for the future, the government being a socially responsible one is currently making efforts towards mammographic screening in Malaysia. However understanding of the disease, acceptance of medical treatment and providing resources is imperative to ensure that health behaviour exhibited by our women is not self-destructive but self-preserving. Women are an integral part of not only the nation's workforce but the lifeline of the family - hopefully in the next decade we will see great improvement in the survival of Malaysian women with breast cancer.
    Matched MeSH terms: Health Resources
  10. Royston G, Hagar C, Long LA, McMahon D, Pakenham-Walsh N, Wadhwani N, et al.
    Lancet Glob Health, 2015 Jul;3(7):e356-7.
    PMID: 26087979 DOI: 10.1016/S2214-109X(15)00054-6
    Matched MeSH terms: Health Resources
  11. Mohd Yusoff MI
    Comput Math Methods Med, 2020;2020:9328414.
    PMID: 33224268 DOI: 10.1155/2020/9328414
    Researchers used a hybrid model (a combination of health resource demand model and disease transmission model), Bayesian model, and susceptible-exposed-infectious-removed (SEIR) model to predict health service utilization and deaths and mixed-effect nonlinear regression. Further, they used the mixture model to predict the number of confirmed cases and deaths or to predict when the curve would flatten. In this article, we show, through scenarios developed using system dynamics methodology, besides close to real-world results, the detrimental effects of ignoring social distancing guidelines (in terms of the number of people infected, which decreased as the percentage of noncompliance decreased).
    Matched MeSH terms: Health Resources
  12. Raman S, Shafie AA, Abraham MT, Shim CK, Maling TH, Rajendran S, et al.
    PLoS One, 2021;16(5):e0251760.
    PMID: 33984051 DOI: 10.1371/journal.pone.0251760
    Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider's perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection.
    Matched MeSH terms: Health Resources
  13. Tengku Ariff, R.H., Mohd Nazi, M.Z., Mohd Rizam, M.Z., Mohd Shahriman, M.S., Zakaria, Y., Kamal Nazmir, K., et al.
    MyJurnal
    This study was conducted to determine the health status of aboriginal ("Orang Asli') children aged 0-12 years in Post Brooke, Gua Musang, Kelantan. This is done by appraising the environmental status, patterns of illnesses including communicable diseases and usage of health resources. Six villages were selected randomly from 12 villages in the area; 179 families were interviewed, 200 under-12-year-olds were examined and their blood samples taken for haemoglobin (HB) estimation as well as malarial screening. Water supply through Gravity Feed System (GFS) was used by 134 families (70.2%) whilst the rest obtained water direct from the river for the purpose. Only 63.6% of families boiled their drinking water 56.4% families threw rubbish indiscriminately, while 82.1% used the river as their toilets. Eighty-seven percent of the families saw the village medicine man first when ill. Forty (22.2%) children had had serious illnesses including malaria and 24 were admitted to hospitals. 15% of the children had never been immunized. A total of 102 (51%) children were pale and 90 (45%) had brown hair. Eighty nine (44.5%) of the children were anaemic (Hb < 10 gm/di). Sixty-nine children (34%) had dental caries. Forty-two (21%) had distended abdomen and 37 (18.5%) had hepatomegaly. Out of 84 stool samples examined, 67 (79.8%) had helminthic ova. Of all families, 47.1% gave a past history of at least one baby among their children who had died due to one reason or another. The health status of this community (especially children) was low that it warrants special attention.
    Matched MeSH terms: Health Resources
  14. Dixit SK, Sambasivan M
    SAGE Open Med, 2018;6:2050312118769211.
    PMID: 29686869 DOI: 10.1177/2050312118769211
    This article seeks to review the Australian healthcare system and compare it to similar systems in other countries to highlight the main issues and problems. A literature search for articles relating to the Australian and other developed countries' healthcare systems was conducted by using Google and the library of Victoria University, Melbourne. Data from the websites of the Commonwealth of Australia, the Australian Institute of Health and Welfare, the Australian Productivity Commission, the Organisation for Economic Co-operation and Development and the World Bank have also been used. Although care within the Australian healthcare system is among the best in the world, there is a need to change the paradigm currently being used to measure the outcomes and allocate resources. The Australian healthcare system is potentially dealing with two main problems: (a) resource allocation, and (b) performance and patient outcomes improvements. An interdisciplinary research approach in the areas of performance measurement, quality and patient outcomes improvement could be adopted to discover new insights, by using the policy implementation error/efficiency and bureaucratic capacity. Hospital managers, executives and healthcare management practitioners could use an interdisciplinary approach to design new performance measurement models, in which financial performance, quality, healthcare and patient outcomes are blended in, for resource allocation and performance improvement. This article recommends that public policy implementation error and the bureaucratic capacity models be applied to healthcare to optimise the outcomes for the healthcare system in Australia. In addition, it highlights the need for evaluation of the current reimbursement method, freedom of choice to patients and a regular scrutiny of the appropriateness of care.
    Matched MeSH terms: Health Resources
  15. Alkhawari M, Ali K, Al-Abdul Razzaq F, Saleheen HN, Almuneef M, Al-Eissa MA
    Public Health, 2020 Apr;181:182-188.
    PMID: 32088599 DOI: 10.1016/j.puhe.2020.01.005
    OBJECTIVE: To assess the readiness to implement child maltreatment (CM) prevention programs at a national level.

    STUDY DESIGN: This is a cross-sectional study.

    METHODS: This study was completed alongside similar studies undertaken by the rest of the Gulf Cooperation Council (GCC) countries and led by Kingdom of Saudi Arabia (KSA). The study will allow further understanding of possible obstacles that may be encountered while implementing a nationwide prevention program. The 10-dimensional model of readiness had been developed by the World Health Organization (WHO) in collaboration with five countries (Brazil, The Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa) through a five-stage process. Stakeholders and decision makers were invited to participate. Scores for each dimension were compared with those for the rest of the GCC countries.

    RESULTS: The overall score of Kuwait was 39.17 out of 100. This was below the mean average score for the GCC countries (47.83). Out of the 10 dimensions, key informants scored the highest on legislation, mandates and policies (6.61). The lowest score was reported on attitudes towards CM prevention (1.94). Informal social resources (5.72) ranked the highest as compared to the rest of the GCC countries.

    CONCLUSIONS: The readiness of Kuwait is weak on several dimensions and needs to be strengthened. Despite that, the country is moderately ready to implement large-scale evidence-based CM prevention programs because it is strong in the infrastructure of knowledge, legislation, mandates, and policies and informal social resources.

    Matched MeSH terms: Health Resources
  16. Poh KW, Ngan CH, Wong JY, Ng TK, Mohd Noor N
    Int J Health Care Qual Assur, 2020 Feb 25;ahead-of-print(ahead-of-print).
    PMID: 32108452 DOI: 10.1108/IJHCQA-11-2019-0195
    PURPOSE: There was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban.

    DESIGN/METHODOLOGY/APPROACH: Preinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care.

    FINDINGS: There was a significant overall reduction of CLABSI rate between preintervention and postintervention period [incidence rate ratio (IRR) of 0.06 (95 percent CI, 0.01-0.33; P = 0.001)].

    PRACTICAL IMPLICATIONS: CLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI.

    ORIGINALITY/VALUE: This study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.

    Matched MeSH terms: Health Resources
  17. Schliemann D, Ramanathan K, Matovu N, O'Neill C, Kee F, Su TT, et al.
    BMC Cancer, 2021 Oct 19;21(1):1125.
    PMID: 34666704 DOI: 10.1186/s12885-021-08809-1
    BACKGROUND: Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs.

    METHODS: We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries.

    RESULTS: CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was 'uptake/reach'. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes.

    CONCLUSION: Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.

    Matched MeSH terms: Health Resources
  18. Lim RZM, Lee T, Ng JYZ, Quek KF, Abdul Wahab N, Amansah SL, et al.
    J Pediatr Surg, 2018 Nov;53(11):2312-2317.
    PMID: 29459045 DOI: 10.1016/j.jpedsurg.2018.01.004
    BACKGROUND/PURPOSE: Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water.

    METHODS: This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression.

    RESULTS: Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3years old (aOR=7.16; 95% CI=1.07-47.94; p=0.042), anemia (aOR=10.12; 95% CI=1.12-91.35; p=0.039), thrombocytosis (aOR=11.21; 95% CI=2.06-64.33; p=0.005) and ultrasound findings of free fluid (aOR=9.39; 95% CI=1.62-54.38; p=0.012) and left-sided intussusception (aOR=8.18;95% CI=1.22-54.90, p=0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association.

    CONCLUSIONS: USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study.

    TYPE OF STUDY: Treatment study LEVEL OF EVIDENCE: III.

    Matched MeSH terms: Health Resources
  19. Ismail, I., Yap, B.W., Abidin, A.S.Z.
    MyJurnal
    Prolonged mechanical ventilation (PMV) is associated with increase in mortality and resource utilisation as well as hospitalisation costs. This study evaluates the risk factors of PMV. A retrospective study was conducted involving 890 paediatric patients comprising 237 neonates, 306 infants, 223 of pre-school age and 124 who are of school going age. The data mining decision trees algorithms and logistic regression was employed to develop predictive models for each age category. The independent variables were classified into four categories, that is, demographic data, admission factors, medical factors and score factors. The dependent variable is the duration of ventilation where it is categorized 0 denoting non-PMV and 1 denoting PMV. The performances of three decision tree models (CHAID, CART and C5.0) and logistic regression were compared to determine the best model. The results indicated that the decision tree outperformed the logistic regression model for all age categories, given its good accuracy rate for testing dataset. Decision trees results identified length of stay and inotropes as significant risk factors in all age categories. PRISM 12 hours and principal diagnosis were identified as significant risk factors for infants.
    Matched MeSH terms: Health Resources
  20. Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, et al.
    Brachytherapy, 2017 Jan-Feb;16(1):85-94.
    PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007
    PURPOSE: Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings.

    METHODS AND MATERIALS: A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC.

    RESULTS: Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article.

    CONCLUSIONS: Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
    Matched MeSH terms: Health Resources
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