OBJECTIVES: To determine the prevalence of depression, anxiety and stress among HO in Sarawak General Hospital (SGH), Kuching, Sarawak. The socialdemographic factors were also evaluated to identify the high-risk groups.
MATERIALS AND METHODS: This is a descriptive cross-sectional study involving 227 house officers in SGH over a period of three months. The social-demographic data such as age, sex, marital status, current posting, duration of posting, place of graduate and state of origin were obtained from interviews with the respondents. The Depression, Anxiety and Stress scale (DASS) questionnaire was completed to assess the psychological morbidities.
RESULTS: HO were found to have high prevalence of psychiatric morbidities such as depression (42%), anxiety (50%) and stress (42.7%). Foreign graduates showed a significantly higher odds of depression (odds ratio, OR: 3.851; 95% confidence interval, 95%CI: 2.165, 6.851), anxiety (OR: 2.427; 95%CI: 1.394, 4.225) and stress (OR: 2.524; 95%CI: 1.439, 4.427) as compared to local graduates.. Further, non-Sarawakians were observed to have higher odds of developing anxiety (OR: 1.772; 95%CI: 1.022, 3.073) as compared to the Sarawakians.
CONCLUSION: HO in SGH had high prevalence of depression, anxiety and stress. Therefore, psychiatric morbidities should be screened regularly amongst the HOs in Malaysia.
DESIGN: A retrospective study.
METHODS: Patients who underwent cataract surgery from January 2011 to December 2012 in a hospital in Malaysia were studied. The data were obtained from the National Eye Database of Malaysia.
RESULTS: Of 80.4% eyes (2519) that had undergone phacoemulsification, it was found that 3.06% (77) of the cases had PCR as one of the complications. The largest number of PCRs happened during cortical removal (35.2%), followed by segment removal (25.4%), cracking (8.5%), and aspiration of the oculoviscodevice (8.5%). It has been found that the rupture most often occurred during cortex removal by consultants, whereas most PCRs occurred during segment removal by specialists.
CONCLUSIONS: This study reveals that around 3% of patients had PCR during phacoemulsification. It is important to recognize PCR and presence of vitreous loss intraoperatively to prevent further complications of cystoid macular edema and endophthalmitis.
OBJECTIVES: To assess the effectiveness of centralisation of care for patients with gynaecological cancer.
SEARCH METHODS: We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies.
SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix.
DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis.
MAIN RESULTS: Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias.Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies.
AUTHORS' CONCLUSIONS: We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers.Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.
METHODS: This retrospective study covered all NPC patients who underwent radical IMRT treatment at the Penang General Hospital from June 2011 to February 2012. Patients of any age and stage of disease with histologically proven diagnosis were included. Information was collected on patient demographics, clinical stage, treatment received, including any neoadjuvant and/or concurrent chemotherapy, acute toxity and completion of IMRT within the OTT.
RESULTS: A total of 26 NPC patients were treated with IMRT during the study period; 88.5% had stage III/IV disease. 45.2% received neo-adjuvant chemotherapy while 50.0% were given concurrent chemo-irradiation. All patients completed the treatment and 92.3% within the 7 weeks OTT. Xerostomia was present in all patients with 92.3% having grade 2. Severe grade III/IV acute toxicity occurred in 73.1% of patients, the commonest of which was oral mucositis (57.6%). This was followed by dysphagia which occurred in 53.8%, skin reactions in 42.3% and weight loss in 19.2%. However, haematological toxicity was mild with only one patient having leucopaenia.
CONCLUSION: IMRT treatment for NPC is feasible in our center. More importantly, it can be delivered within the 7 weeks OTT in the majority of patients. Severe grade 3/4 toxicity is very common (73.1%) and thus maximal nutritional and analgesic support is required throughout the treatment.