A case report of right below-knee amputation successfully performed under acupuncture anaesthesia, supplemented with parenteral valium and. pethidine, is described.
A' brief' of an attempt in integration of health education of patients as a part and parcel of treatment and management in hospitals in Kelantan is outlined. The methodology used in the context of local situation is described, problems and short-comings highlighted, and a few suggestions made including recommendations for further such trial efforts in other hospitals in the country.
Concerned by the alarming decline in breast feeding in the urban and rural areas of Malaysia, we conducted a critical review of infant feeding practices among nursing personnel from representative centres using questionnaires. It was found that although 75% of mothers breast-fed their babies at birth only 19% did so at 2 months and 5% at 6 months respectively. Chinese mothers initiated breast feeding less frequently compared with Indian or Malay mothers. The prevalence of breast feeding was higher among lower category nurses, lower income groups and those from health centres. Decision for breast feeding was based in most instances on conviction derived from reading, lectures or advice from relatives. The vast majority of mothers listed "work' as the main reason for termination of breast feeding followed by "insufficient breast milk' and satisfactory past experience with bottle feeding. The ramifications of these findings and measures to improve the prevalence and duration of breast feeding are discussed.
This is a study of 110 married men as to their attitudes to family planning. Most of the respondents approved of family planning. There is a reluctance to plan families before the first child. more among the Malays than among the Indians. Majority of the respondents [81%] have discussed family planning with their wives, and are also willing to allow their wives to practise family planning. Induced abortion is not favoured by the respondents especially the Malays. Only half the respondents are practising family planning and it appears that the better educated approve as well as practise family planning more than those with less education. A large proportion [89%] of respondents are interested in learning more about family planning.
Study site: Army Garrison Hospital, Port Dickson, Negeri Sembilan, Malaysia
The paper discusses the results of 24 cases of Millin's prostatectomy in a District Hospital carried out between April and December 1983. The results show that the blood loss in the operation is usually not more than 600ml and therefore would not pose a strain on the blood bank. Postoperative bleeding is very minimal and again does not tax the nursing staff of an overcrowded, large ward in the District Hospital. The results for the patients are excellent.
This paper is based on the beta-thalassaemia programme at the Duchess of Kent Hospital, Sandakan, Sabah. It seeks to show that a hypertransfusion regimen which improves the quality of life of children with thalassaemia major can be practised in district and general hospitals if there is an organised blood recruitment programme, at least at departmental level. Such a programme reduces the demand on the hardpressed hospitals' blood banks. Frequent and regular transfusions can be given with minimal interference with the school and family life of affected children and reduces immeasurably the social, emotional and financial strain on the affected families. There is also an urgent need to define the magnitude of the problem of beta-thalassaemia through population studies so that genetic counselling can be given and adequate resources can be allocated to improve the quality of life of affected patients.
A retrospective study of 224 cases of snake bites in Bukit Mertajam Hospital over a two year period is reported. Snake bites formed 0.5% of the total and 1.7% of the Medical and Paediatric admissions and accounted for 0.3% of the total hospital deaths. The commonest snake species involved was the Malayan pit viper. 89% of the patients escaped with negligible poisoning and went home in less than seven days. Most of the bites were inflicted in the lower limbs and occurred in the dark. Only 5% of the patients were given anti-venom, of whom one-third had adverse reaction.
An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia
Undetected hypertension is an obstacle to effective blood pressure control in the community. A study was done to assess the justification of screening in the outpatient department. Only 13% of all visits to the outpatient department resulted in an attempt to detect hypertension. The common reasons leading to blood pressure measurement were headache and dizziness. Current practice of hypertension detection appeared inadequate and irrational. Nine per cent of all visits to the outpatient department were already accounted for by hypertensives. A screening survey found that 30% of all non-hypertensive patients attending outpatient department aged 30 years or more had blood pressure greater than or equal to 140/90 mmHg. The drop out rate among these newly diagnosed hypertensives was 100%. Existing resources are already inadequate and existing hypertension care has also been shown to be inadequate. Screening can only be expected to considerably increase hypertensive patient load without however any assurance that effective long term care can be delivered. Labelling people as hypertensives in this manner may be harmful. The question of screening cannot be considered individually, separate from the entire problem of hypertension control. Detection must be linked to treatment in a programme designed to promote compliance and capable of delivering adequate care before it can be justified.
An audit to assess the adequacy of hypertension care was performed by examining the records and interviewing 55 selected hypertensive patients on treatment and follow-up at the outpatient department of a hospital. The patients selected had no previous record of drop out of treatment and had excellent compliance with drug therapy, so that ineffective blood pressure control cannot be attributable to these two reasons. Adequacy of care was measured by the number of patients whose management as indicated in their records complied with pre-defined criteria of adequate care. Only 18% of patients had achieved adequate blood pressure control. Assessment of patients was inadequate. None of the patients had been screened for secondary causes though 16% of patients had some basic investigations (urinalysis, blood urea and serum potassium), 5% had an assessment of target-organ damage, and 2% had been screened for other cardiovascular risk factors. Only 5% had a surveillance of side-effects from drug-therapy, 45% of the patients demonstrate adequate knowledge concerning complications of hypertension. The use of non-drug treatment was non-existent. The results of this study suggest that there were considerable deficiencies in the management of hypertension. Measures needed to overcome this are discussed.
Poor compliance with drug treatment is a barrier to effective management of hypertension. Drug compliance behaviour of 168 patients were studied, their drug compliance was measured by the pill-counting method. The prevalence of non-compliance with medication was 26%. Thirteen variables were examined for their association with compliance; these were age, sex, duration of hypertension since diagnosis, adequacy of blood pressure control, complexity of drug regimen and side-effect of drug, history of previous admission for hypertension related reason, patient's knowledge of hypertensive complications, patient's belief that drug was 'panas' or 'san', previous use of traditional treatment for hypertension, patient's fatalistic attitude, their social support and satisfaction with the health services. None of these variables were significantly related to compliance (p greater than 0.05) except adequacy of blood pressure control. The performance of patient self-report was compared with pill-count as a measure of drug compliance; it was poorly predictive of non-compliance (sensitivity = 71%, specificity = 50%). An inverse relationship was found between non-compliance with medication and patient subsequent drop-out rate. Patients who were compliant were more likely to remain on treatment and vice versa. As a measure of drug compliance, detection of drop-out compared well with pill-count (sensitivity 97%, specificity 66%, positive predictive value 89%, negative predictive value 88%).
Study site: outpatient clinic, Hospital Mentakab, Pahang, Malaysia
A study was undertaken to determine the extent of morbidity associated with asthma and to audit the management of asthma in two out-patient clinics of two district hospitals. Patients were recruited for the study during a 3-month period from December 1990 to February 1991. Seventy asthmatic patients were studied. Eighty-six percent of the patients had their sleep disturbed by asthma, 77% took daily medication regularly, 63% felt that their activities were restricted by asthma, 60% had at least one acute exacerbation in the preceding six months. Of those who had their peak expiratory flow rate (PEFR) measured, 40% had a PEFR below 50% predicted, and only 11% had normal PEFR (greater than 80% predicted). The morbidity of asthma was thus considerable. On the other hand, the drug treatment of these asthmatics was grossly inadequate. They were prescribed on average 2.1 item of drugs, which for most patients comprised an oral beta agonist and a theophylline. Only 43% of the patients received inhaler therapy, but no patients were given steroids, inhaled or oral. The drug treatment was unrelated to the severity of patients' asthma. Further, objective measurement of severity was under-used in the assessment of asthma, only 8.5% of patients ever had their PEFR recorded. This study has found that asthma is poorly managed in out-patient clinics. We need to improve the training of doctors in the optimal management of asthma.
Study site: General outpatient clinics, district hospitals, Pahang, Malaysia