Displaying publications 1 - 20 of 252 in total

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  1. Low CS, Ho JJ, Nallusamy R
    World J Pediatr, 2016 Nov;12(4):450-454.
    PMID: 27286688 DOI: 10.1007/s12519-016-0037-7
    BACKGROUND: Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country.

    METHODS: The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events.

    RESULTS: Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055).

    CONCLUSION: Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.
    Matched MeSH terms: Outcome Assessment (Health Care)*
  2. Dilokthornsakul P, McQueen RB, Chaiyakunapruk N, Spackman E, Watanabe JH, Campbell JD
    Value Health Reg Issues, 2016 May;9:99-104.
    PMID: 27881269 DOI: 10.1016/j.vhri.2015.12.003
    Health technology assessment is a form of health policy research that provides policymakers with information relevant to decisions about policy alternatives. Findings from cost-effectiveness analysis (CEA) are one of the important aspects of health technology assessment. Nevertheless, the more advanced method of value of information (VOI), which is recommended by the International Society for Pharmacoeconomics and Outcomes Research and Society for Medical Decision Making Modeling Good Research Practices Task Force, has rarely been applied in CEA studies in Asia. The lack of VOI in Asian CEA studies may be due to limited understanding of VOI methods and what VOI can and cannot help policy decision makers accomplish. This concept article offers audiences a practical primer in understanding the calculation, presentation, and policy implications of VOI. In addition, it provides a rapid survey of health technology assessment guidelines and literature related to VOI in Asia and discusses the future directions of VOI use in Asia and its potential barriers. This article will enable health economists, outcomes researchers, and policymakers in Asia to better understand the importance of VOI analysis and its implications, leading to the appropriate use of VOI in Asia.
  3. Santos J, Palumbo F, Molsen-David E, Willke RJ, Binder L, Drummond M, et al.
    Value Health, 2017 12;20(10):1227-1242.
    PMID: 29241881 DOI: 10.1016/j.jval.2017.10.018
    As the leading health economics and outcomes research (HEOR) professional society, ISPOR has a responsibility to establish a uniform, harmonized international code for ethical conduct. ISPOR has updated its 2008 Code of Ethics to reflect the current research environment. This code addresses what is acceptable and unacceptable in research, from inception to the dissemination of its results. There are nine chapters: 1 - Introduction; 2 - Ethical Principles respect, beneficence and justice with reference to a non-exhaustive compilation of international, regional, and country-specific guidelines and standards; 3 - Scope HEOR definitions and how HEOR and the Code relate to other research fields; 4 - Research Design Considerations primary and secondary data related issues, e.g., participant recruitment, population and research setting, sample size/site selection, incentive/honorarium, administration databases, registration of retrospective observational studies and modeling studies; 5 - Data Considerations privacy and data protection, combining, verification and transparency of research data, scientific misconduct, etc.; 6 - Sponsorship and Relationships with Others (roles of researchers, sponsors, key opinion leaders and advisory board members, research participants and institutional review boards (IRBs) / independent ethics committees (IECs) approval and responsibilities); 7 - Patient Centricity and Patient Engagement new addition, with explanation and guidance; 8 - Publication and Dissemination; and 9 - Conclusion and Limitations.
  4. De Britto RLJ, Vijayalakshmi G, Boopathi K, Kamaraj P, Supriya VK, Yuvaraj J
    Trop Biomed, 2020 Mar 01;37(1):66-74.
    PMID: 33612719
    Advocacy and training on "Home care" for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 - 1935) at first visit of the observation period which reduced to 645ml (IQR 215- 1666) and 752ml (IQR 215 - 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.
    Matched MeSH terms: Outcome Assessment (Health Care)*
  5. El Hajj MS, Awaisu A, Kheir N, Mohamed MHN, Haddad RS, Saleh RA, et al.
    Trials, 2019 Jan 08;20(1):25.
    PMID: 30621772 DOI: 10.1186/s13063-018-3068-7
    BACKGROUND: Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar.

    METHODS/DESIGN: The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach.

    DISCUSSION: If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder.

    TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03518476 . Registered on 8 May 2018. Version 1/22 June 2018.

  6. Kim KT, Morton S, Howe S, Chiew YS, Knopp JL, Docherty P, et al.
    Trials, 2020 Feb 01;21(1):130.
    PMID: 32007099 DOI: 10.1186/s13063-019-4035-7
    BACKGROUND: Positive end-expiratory pressure (PEEP) at minimum respiratory elastance during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) may improve patient care and outcome. The Clinical utilisation of respiratory elastance (CURE) trial is a two-arm, randomised controlled trial (RCT) investigating the performance of PEEP selected at an objective, model-based minimal respiratory system elastance in patients with ARDS.

    METHODS AND DESIGN: The CURE RCT compares two groups of patients requiring invasive MV with a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio ≤ 200; one criterion of the Berlin consensus definition of moderate (≤ 200) or severe (≤ 100) ARDS. All patients are ventilated using pressure controlled (bi-level) ventilation with tidal volume = 6-8 ml/kg. Patients randomised to the control group will have PEEP selected per standard practice (SPV). Patients randomised to the intervention will have PEEP selected based on a minimal elastance using a model-based computerised method. The CURE RCT is a single-centre trial in the intensive care unit (ICU) of Christchurch hospital, New Zealand, with a target sample size of 320 patients over a maximum of 3 years. The primary outcome is the area under the curve (AUC) ratio of arterial blood oxygenation to the fraction of inspired oxygen over time. Secondary outcomes include length of time of MV, ventilator-free days (VFD) up to 28 days, ICU and hospital length of stay, AUC of oxygen saturation (SpO2)/FiO2 during MV, number of desaturation events (SpO2 care environment.

    TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry, ACTRN12614001069640. Registered on 22 September 2014. (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366838&isReview=true) The CURE RCT clinical protocol and data usage has been granted by the New Zealand South Regional Ethics Committee (Reference number: 14/STH/132).

  7. Austin A, De Silva U, Ilesanmi C, Likitabhorn T, Miller I, Sousa Fialho MDL, et al.
    Lancet Psychiatry, 2023 Dec;10(12):966-973.
    PMID: 37769672 DOI: 10.1016/S2215-0366(23)00265-1
    The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.
  8. Loeliger KB, Altice FL, Desai MM, Ciarleglio MM, Gallagher C, Meyer JP
    Lancet HIV, 2018 02;5(2):e96-e106.
    PMID: 29191440 DOI: 10.1016/S2352-3018(17)30209-6
    BACKGROUND: Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services.

    METHODS: To create a retrospective cohort of all adults with HIV released from jails and prisons in Connecticut, USA (2007-14), we linked administrative custody and pharmacy databases with mandatory HIV/AIDS surveillance monitoring and case management data. We examined time to LTC (defined as first viral load measurement after release) and viral suppression at LTC. We used generalised estimating equations to show predictors of LTC within 14 days and 30 days of release.

    FINDINGS: Among 3302 incarceration periods for 1350 individuals between 2007 and 2014, 672 (21%) of 3181 periods had LTC within 14 days of release, 1042 (34%) of 3064 had LTC within 30 days of release, and 301 (29%) of 1042 had detectable viral loads at LTC. Factors positively associated with LTC within 14 days of release are intermediate (31-364 days) incarceration duration (adjusted odds ratio 1·52; 95% CI 1·19-1·95), and transitional case management (1·65; 1·36-1·99), receipt of antiretroviral therapy during incarceration (1·39; 1·11-1·74), and two or more medical comorbidities (1·86; 1·48-2·36). Reincarceration (0·70; 0·56-0·88) and conditional release (0·62; 0·50-0·78) were negatively associated with LTC within 14 days. Hispanic ethnicity, bonded release, and psychiatric comorbidity were also associated with LTC within 30 days but reincarceration was not.

    INTERPRETATION: LTC after release is suboptimal but improves when inmates' medical, psychiatric, and case management needs are identified and addressed before release. People who are rapidly cycling through jail facilities are particularly vulnerable to missed linkage opportunities. The use of integrated programmes to align justice and health-care goals has great potential to improve long-term HIV treatment outcomes.

    FUNDING: US National Institutes of Health.

  9. Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al.
    Lancet Gastroenterol Hepatol, 2020 08;5(8):739-752.
    PMID: 32413340 DOI: 10.1016/S2468-1253(20)30077-7
    BACKGROUND: Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level.

    METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD.

    FINDINGS: We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9-23·0) of people were lean and 40·8% (36·6-45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3-15·6) of people had non-obese NAFLD and 5·1% (3·7-7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4-39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1-56·3) had non-alcoholic steatohepatitis, 29·2% (21·9-37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5-5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5-38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9-7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1-14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0-18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2-31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5-77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity.

    INTERPRETATION: Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges.

    FUNDING: None.

  10. Indirayani I, Kalok A, Nik Ismail NA, Shah SA, Lim PS, Mohamed Ismail NA, et al.
    J Obstet Gynaecol Res, 2018 Aug;44(8):1458-1465.
    PMID: 29845672 DOI: 10.1111/jog.13686
    AIM: Sodium pentosan polysulfate (Na-PPS) is a plant-based agent that has similar action with low-molecular-weight heparin. It inhibits factor Xa, preventing blood clot formation. To date, its use in clinical practice as thromboprophylaxis agent is still limited. In addition, the efficacy and safety profile of this agent was not robustly reported globally, especially for countries with major Muslim population. We hypothesized that Na-PPS was equally effective as the standard thromboprophylaxis. We aim to compare the efficacy and safety of Na-PPS against standard agent (fondaparinux or enoxaparin).

    METHODS: This was a randomized control, open-label trial. Women underwent major gynecological surgery were randomized to receive either subcutaneous 50 mg of Na-PPS twice daily or subcutaneous enoxaparin 40 mg once daily. Fondaparinux 2.5 mg once daily was given to Muslim women as an alternative to enoxaparin. The treatment was started 6 h postoperatively, for at least 3 days. All the patients received thromboembolic deterrent stockings. The primary efficacy outcome was venous thromboembolism up to 3 days postsurgery. The main safety outcomes were minor and major bleeding.

    RESULTS: Among 109 participants, there was no incidence of venous thromboembolism. None of the women developed major bleeding. Minor bleeding was observed in 28.3% (15/53) and 5.4% (3/56) of Na-PPS and standard thromboprophylaxis group, respectively (P = 0.001).

    CONCLUSION: Na-PPS was associated with increased risk of minor bleeding. There was insufficient data to conclude its efficacy as thromboprophylaxis. Further research is needed to evaluate Na-PPS safety as a standard thromboprophylactic agent.

    Matched MeSH terms: Outcome Assessment (Health Care)*
  11. Gendeh BS, Salina H, Selladurai B, Jegan T
    Med J Malaysia, 2007 Aug;62(3):234-7.
    PMID: 18246914 MyJurnal
    Craniofacial resection is commonly performed in the surgical resection of sinonasal tumours involving anterior skull base. It entails a bicoronal scalp flap with lateral rhinotomy or an extended lateral rhinotomy to expose the anterior skull base. Transfacial approach is necessary in the resection of the nasal part of the tumour. The choice of surgical approach is based heavily on the surgeon's experience and training. The results of endoscopic-assisted craniofacial resection for sinonasal tumours performed in our center in eight patients from 1998 to 2005 were reviewed. There were seven males and one female with age ranging from 18 to 62 years (mean 42.4 years). There was each a case of mature teratoma, poorly differentiated squamous cell carcinoma, undifferentiated squamous cell carcinoma, olfactory neuroblastoma, fibrous dysplasia, inverted papilloma and two cases of sinonasal neuroendocrine carcinoma. The mean follow up duration for these eight patients post surgery was 21.4 months. Out of eight patients, five underwent surgery with no adverse complications. The complications encountered were a cerebrospinal leak and a postoperative transient V and VI cranial nerve palsy. One patient with sinonasal undifferentiated carcinoma died of lung metastasis at 11 months post-surgery. The endoscopic-assisted craniofacial resection is a highly useful surgical technique to avoid the unsightly facial scar of the lateral rhinotomy or the Weber-Ferguson incision, postoperative paranasal sinuses infection and avoidance of tracheostomy in selected cases. We found that this approach has lower morbidity rate in selected cases.
    Matched MeSH terms: Outcome Assessment (Health Care)*
  12. Yew BS, Ong WC, Chow WC, Lui HF
    Med J Malaysia, 2007 Aug;62(3):201-5.
    PMID: 18246907
    This retrospective study evaluated patients admitted to the Department of Gastroenterology, Singapore General Hospital for variceal bleeding in the year 2004. Improvement in outcome of variceal bleeding has been reported in the West. There is no regional data on this condition. This study aims to determine the characteristics and outcome of variceal bleeding in a tertiary hospital in Southeast Asia. Twenty-two patients were eligible. The main aetiologies of liver cirrhosis were chronic hepatitis B (38%) and alcohol (33%). Child's A, B and C were 29%, 48% and 24% respectively. Nineteen patients (86%) had bleeding oesophageal varices (band ligation performed). The remaining three patients (14%) had bleeding gastric varices (N-butyl-2-cyanoacrylate injection performed). Detailed description of certain endoscopic findings was absent in up to 18 patients (82%). All patients received antibiotics and vasoactive drug. In-hospital mortality and rebleeding were 9% and 18% respectively. We conclude that the relatively low in-hospital mortality and rebleeding rates in our series are most probably due to the smaller proportion of patients with severe liver dysfunction and management which adhered to recommendations. Documentation of endoscopic findings needs to be improved to facilitate the continuation of care.
    Matched MeSH terms: Outcome Assessment (Health Care)*
  13. Saiful Azli MN, Abd Rahman IG, Md Salzihan MS
    Med J Malaysia, 2007 Aug;62(3):256-8.
    PMID: 18246922 MyJurnal
    Cystic spinal or ancient schwannoma is a rare form of intradural tumour especially in the conus medullaris region. Due to its indolent behavior and benign course, the diagnosis of schwannoma is always a challenge and the imaging findings can be misleading. Our patient presented with chronic mild sciatica pain without any other neurological symptom. MRI of the spine showed intradural tumour located at the conus medullaris region with nerves compression and was reported as ependymoma. L3-L5 laminectomy and total excision of tumour was performed without any neurological complication. We concluded that ancient schwannoma of the conus medullaris is a rare benign tumour that can present with minimal non-specific neurological symptom that lead to misdiagnosis. Radical tumour excision is safe with an excellent outcome.
  14. Tan WC, Ong CK, Lo KS, Leong KN
    Med J Malaysia, 2007 Aug;62(3):251-3.
    PMID: 18246920 MyJurnal
    Pyoderma Gangrenosum (PG) is a non-infective, necrotising neutrophilic dermatosis. Many diseases may mimic PG. It may be idiopathic or may be associated with a systemic disorder. We report a case of PG in association with ulcerative colitis.
  15. Chan CY, Nam HY, Raveenthiran R, Choon SK, Tai CC
    Med J Malaysia, 2008 Jun;63(2):100-3.
    PMID: 18942292 MyJurnal
    An anaesthetist-led outpatient pre-operative assessment (OPA) clinic was introduced in our unit in an effort to improve patient care and cost-effectiveness. To assess the efficiency of the clinic, 112 patients who attended the OPA clinic (attendance rate 98%) during the first year were assessed prospectively and compared with 118 patients who did not undergo OPA the year before. There were fewer cancellations among those who attended the OPA clinic (13.6% compared to 3.6%), and the hospital stay was shortened from an average of 10.7 days to 7.0 days. This has resulted in more efficient utilization of operating theatre, reduced hospital costs and improved patient satisfaction. More extensive use of the pre-admission clinic is recommended and should be explored in other clinical settings.
    Study site: Outpatient Preoperative Assessment (OPA) clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  16. Tang IP, Shashinder S, Kuljit S, Gopala KG
    Med J Malaysia, 2007 Mar;62(1):53-5.
    PMID: 17682572
    We reviewed the recurrence rate and possible factors influencing recurrence of preauricular sinus after excision. Seventy-one patients with 73 preauricular sinuses seen at our centre from year 2000 to 2005 were reviewed in this study. The overall recurrence rate was 14.1%. Twelve sinuses needed to be drained for an abscess prior to a definitive surgery. Different modalities used in demonstrating the sinus tract between methylene blue alone and probing together with methylene blue, showed different outcomes, which were statistically significant with a p value of < 0.05(chi-square test). A preauricular sinus with a previous history of infection or actively infected during the definitive surgery may have a higher tendency of recurrence. Meanwhile demonstrating the sinus tract by probing with lacrimal probe/sinus probe followed by injection of methylene blue reduces the recurrence rate (p < 0.05 with chi-square test).
    Matched MeSH terms: Outcome Assessment (Health Care)*
  17. Chan CY, Kwan MK, Saravanan S, Saw LB, Deepak AS
    Med J Malaysia, 2007 Mar;62(1):33-5.
    PMID: 17682567 MyJurnal
    Assessment of the curve flexibility is a crucial step in a surgeon's pre-operative planning for scoliosis surgery. Many techniques have been described. These include traction films, supine side bending films, push prone techniques, traction under general anaesthesia as well as fulcrum bending film. In this study, we studied the pre- and immediate post-operative radiographs of twenty eight adolescent idiopathic scoliosis (AIS) patients who were corrected using pedicle screw systems between January 2004 and August 2006. There were twenty two females and six male patients. The mean age of the patients were 17.5 years with a range of 12 to 38 years. Skeletal maturity of the patients was assessed by Risser's score. The majority was Risser 4 (15 cases, 53.6%). Based on King and Moe's classification, the most common curve was type 3 curve (15 cases, 53.6%). Among the twenty eight patients, twenty three patients underwent only posterior correction, while 5 patients underwent additional anterior release surgery. The mean pre-operative Cobb's angle for the posterior surgery group was 65.5 +/- 13.9 degrees and the mean post-operative Cobb's angle was 32.9 +/- 12.6 degrees. There was no difference between the mean correction estimated by fulcrum bending films (Fulcrum Flexibility) and the post- operative Correction Rate figures (44.2% vs. 49.9%). The mean Fulcrum Bending Correction Index (FBCI) in this group of patients is 112.8%. In the group of patients who underwent additional anterior release, their curves were noted to be larger and less flexible with the mean pre-operative Cobb's angle and Fulcrum Flexibility of 90.4 degrees +/- 9.3 degrees and 23.4% respectively. The Fulcrum Bending Correction Index (FBCI) for this group of patients was significantly higher than the posterior surgery group: i.e. 164.0% vs 112.8%. Thus, anterior release does help to improve the correction significantly. The fulcrum bending films give good pre-operative estimation of the amount of correction to be expected post-operatively. The fulcrum bending films can help to identify the curve types which might require anterior release in order to improve the scoliosis correction. Using the Fulcrum Bending Correction Index (FBCI) will also enable surgeons to quantify more accurately the amount of correction achieved by taking into account the inherent flexibility of the spine.
    Matched MeSH terms: Outcome Assessment (Health Care)*
  18. Chow YW, Lim BB, Hooi LS
    Med J Malaysia, 2007 Mar;62(1):27-32.
    PMID: 17682566 MyJurnal
    A three month prospective study was carried out in 1994 (8/3/94 - 7/6/94) and late 2004/early 2005 (24/11/2004 - 15/2/2005) among patients with acute renal failure (ARF) (serum creatinine > 0.200 mmol/1). Incidence of ARF had increased from 0.48% (78/16,418) to 1.1% (211/18,697) of admissions between 1994 and 2004. Two thirds of patients were male. Mean age was 57.7 +/- 20.1 years in 1994 and 55.6 +/- 17.8 years in 2004. No difference was noted in causative factors, rate of oliguric ARF (about 10%) and mean peak urea and creatinine. The cause was pre-renal failure in 43.6% in 1994 and 53.5% in 2004. The second commonest cause was sepsis with 41% in 1994 and 37.9% in 2004. One in six patients needed dialysis and peritoneal dialysis was the main dialysis modality (69.2% and 74.3%). Mortality was 56.4% in 1994 and 44.5% in 2004. A quarter of deaths occurred within two days of admission due to severe underlying illness. Mortality among non-oliguric patients decreased from 52.9% in 1994 to 37.0% in 2004 (p = 0.04); for patients from intensive care units it was 78.3% in 1994 and 68.5% in 2004.
  19. Noor SM, Phipps ME, Fong MY, Chan LL
    Med J Malaysia, 2007 Mar;62(1):23-6.
    PMID: 17682565 MyJurnal
    Allogeneic stem cell transplantation is a treatment option for malignant and non-malignant disorders in children. For children with no HLA-matched sibling or related stem cell donors, there is the option of unrelated cord blood donors. At the University of Malaya Medical Centre (UMMC) in Kuala Lumpur, the first unrelated cord blood transplantation (CBT) was performed in October 1997. All unrelated CBT performed in UMMC relied on cord blood units imported from overseas. DNA typing with variable number of tandem repeat (VNTR) loci was done to qualitatively evaluate engraftment in 15 unrelated CBT. In all the fifteen cases that were evaluated, molecular evidence of engraftment or non-engraftment correlated with the clinical findings.
  20. Gendeh BS, Tan VE
    Med J Malaysia, 2007 Mar;62(1):13-8.
    PMID: 17682563 MyJurnal
    In this case series, the senior author details his series of patients who had undergone open septorhinoplasty for functional and/or aesthetic purposes in the Otorhinolaryngology Department at the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur between January 2003 and September 2005. There were 23 patients, consisting of 15 men and 8 women from different Malaysian ethnic groups. Discussion on open septorhinoplasty with regards to operative technique, grafts and implants is presented from an otorhinolaryngologist's point of view.
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