Introduction: Over three decades, patient-controlled epidural analgesia with a basal infusion
regimen (PCEA+BI) has successfully improved labour analgesia quality due to its advantage
in allowing self-titration by the parturients. Recently, a newer programmed intermittent epidural
bolus with PCEA regimen (PIEB+PCEA) was suggested to improve the epidural spread of
local anaesthetic hence resulted in better analgesia quality and higher maternal satisfaction.
Methods: We conducted a one-year retrospective analysis of data from obstetric analgesia
service record sheet and hospital information system comparing maternal satisfaction towards
their labour analgesia quality, mode of delivery and neonatal Apgar scores between these two
methods of epidural delivery techniques. A total of 343 parturients were recruited in this study
(PCEA+BI n=171, PIEB+PCEA n=172). Results: There were no significant difference in
maternal satisfaction between the two groups (P=0.398) with a higher percentage of excellent
satisfaction were found in the PIEB+PCEA group (PIEB+PCEA 146/172 (84.9%) vs PCEA+BI
138/171 (80.7%)). No significant difference in the mode of delivery (P=0.296). However, the
PIEB+PCEA group shown a higher spontaneous vaginal delivery rate (PIEB+PCEA 87/172
(50.6%) vs PCEA+BI 70/171 (40.9%) and lower Caesarean delivery rate (PIEB+PCEA 71/172
(41.3%) vs PCEA+BI 87/171 (50.9%)). Despite statistically significant differences found in
Apgar scores at 1 minute (P=0.036), there was no significant difference in the scores at 5
minutes (P=0.107). Mean Apgar scores (SD) at 1 minute and 5 minutes for PIEB+ PCEA were
7.77(0.85) and 8.91(0.55) respectively and for PCEA + basal infusion, the scores for 1 minute
and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA is
a newer epidural delivery technique for labour analgesia which produces a comparable
outcome to PCEA with basal infusion.
Background: Diabetic retinopathy (DR) is a microvascular complication of diabetes, which is a cause of visual impairment and blindness. Its development and progression have been linked to dyslipidaemia, although the link remains inconclusive.
Aim: This study aimed to determine the prevalence of dyslipidaemia among type 2 diabetic patients with DR in a tertiary setting and to determine the association between dyslipidaemia and DR severity.
Materials and methods: This was a cross sectional study using retrospective data of type 2 diabetic patients attending the opthalmology clinic of a tertiary centre from January 2007 to June 2014. Results of their fasting lipid profile and clinical data were retrieved from the hospital information system.
Results: A total of 178 patient’s data were collected. 120 (n=67.4%) patients had non-proliferative diabetic retinopathy (NDPR) with moderate NPDR being the most prevalent. Dyslipidaemia was noted in 151 (84.8%) of the patients. Patients had a combination of more than one abnormality in the lipid profile with increased LDL-cholesterol being the main abnormality. Dyslipidaemia was however, not significantly associated with DR severity.
Conclusion: Dyslipidaemia was highly prevalent in DR patients. The dyslipidaemia was however not associated with severity of DR.
Study site: Ophthalmology clinic, Hospital (?name), Malaysia
Drug administration errors were the second most frequent type of medication errors, after prescribing errors but the latter were often intercepted hence, administration errors were more probably to reach the patients. Therefore, this study was conducted to determine the frequency and types of drug administration errors in a Malaysian hospital ward.
Event reporting can provide data to study the failure points of an organization's work process. As part of the ongoing efforts to improve transfusion safety, a Medical Event Reporting System Transfusion Medicine, (MERS - TM) as designed by Kaplan et al was implemented in the Transfusion Medicine Unit of the University Malaya Medical Centre to provide a standardized means of organized data collection and analysis of transfusion errors, adverse events and near misses. An event reporting form was designed to detect, identify, classify and study the frequency and pattern of events occurring in the unit. Events detected were classified according to Eihdhoven Classification model (ECM) adopted for MERS - TM. Since our system reported all events, we called it Event Reporting System - Transfusion Medicine (ERS-TM). Data was collected and analyzed from the reporting forms for a period of five months from January 15th to June 15th 2002. The initial half of the period was a process of evaluation during which 118 events were reported, coded, analyzed and corrective measures adopted to prevent the recurrence of the same event. The latter half saw the reporting of 122 events following the adoption of corrective measures. There was a reduction in the occurrence of some events and an increase in others, which were mainly beyond the organization's control. A longer period of evaluation is necessary to identify the underlying contributory causes that can be useful to develop plans for corrective and preventive action and thereby reduce the rate of recurrence of errors through proper training and adoption of just culture.