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The efficacy of intratympanic steroid injection for the treatment of idiopathic sudden sensorineural hearing loss

Chew SC, Md Daud MK

Med J Malaysia, 2020 01;75(1):74-77.
PMID: 32008025

OBJECTIVE: A systemic steroid is known to have a potential to recover hearing after idiopathic sudden sensorineural hearing loss (ISSHL). However, lately many centres have introduced the use of intratympanic (IT) steroid therapy as an option. We reviewed our experience in the treatment of patients with ISSHL looking at the overall success of using systemic steroid, IT steroid injections as salvage therapy and primary IT steroid injection.
METHODS: A retrospective study was conducted on 20 patients who had suffered from ISSHL from January 1, 2012, to December 31, 2017. ISSHL is defined as a rapid decline in hearing over three days or less affecting three or more frequencies by 30dB or greater. Comparison between the mode of steroid therapies and improvement in patients was done. At least 15dB improvement in pure tone audiogram (PTA) was considered as successful therapeutic intervention.
RESULTS: Twenty male and female patients who fit the inclusion and exclusion criteria were included. The mean age of the patients was 41.4 years with a range from 13 to 72 years. Ninety percent patients presented with unilateral ISSHL involvement. Eight ears of patients who received systemic steroid therapy alone had improved hearings (75%). Out of seven ears from six patients who received salvage therapy, four ears (57.1 %) had improvement in PTA. Seven ears showed improvement in PTA from a total of eight patients who primarily received IT injections.
CONCLUSIONS: IT steroid therapy promises a favourable outcome in the improvement of the hearing, as compared to systemic steroid administration. Its usage is recommended not only for salvage therapy but should be used as primary treatment especially in those with co- morbidities.

Matched MeSH terms: Medical Audit
Fulltext A clinical audit on the care of adult tuberculosis contacts In a public primary care clinic, Malaysia

Ching SM, Hassan F, Paimin F

Malaysian Journal of Medicine and Health Sciences, 2015;11(1):19-25.
MyJurnal

The National Clinical Practice Guideline in Tuberculosis (TB) was designed to improve the quality of tuberculosis care. However, it remains unknown whether primary care doctors adhere to it well. This audit aims to assess the quality of care in the process of TB contact tracing in a primary care setting. Methods: Data on TB contact tracing from 1st February 2013 to 15th February 2013 was obtained retrospectively from all medical records of diagnosed pulmonary TB in a public primary care clinic. All patients who fulfilled the inclusion and exclusion criteria were included in the study. Results: A total of 102 medical records of adult TB contacts were recruited. The median age of the TB contact was 34 (IQR=10) years and 65 % were male. Seventy two percent of the adult TB contact had a TBIS 10C3 form created, and 95% of the medical records were fully documented. History taking and physical examination were recorded on 97% and 99% of patients respectively during the first follow-up at the polyclinic. Eighty five percent and 100% of the patients had a chest-x-ray and sputum direct smear for acid-fast bacilli done respectively. The turn-up rate for the first, second, third and fourth visit was 100% to 32%, 10% and 2% respectively. Conclusion: The quality of care for adult TB contacts tracing in this clinical audit was found to be suboptimal. There is a difference between the current national guidelines and practice in the clinic. Certain measures to improve the quality of care for adult TB contact tracing
are urgently needed.

Matched MeSH terms: Medical Audit
A prospective audit of Desflurane anaesthesia in the University of Malaya Medical Centre Day Surgery Unit

Chiu CL, Mansor M, Wang CY

JUMMEC, 2005;8:45-49.

We evaluated the use of Desflurane anaesthesia in this prospective observational audit in the University of Malaya Medical Centre Day Surgery Unit. Fifty ASA I-II unpremedicated day surgery patients received fentanyl and propofol induction after preoxygenation. Desflurane was introduced initially at 2% and the concentration was increased gradually to 4%, then 6%, 8% and 10% in nitrous oxide and oxygen. Patients breathed spontaneously throughout the surgery. Desflurane was switched off at the end of surgery and patients breathed 100% oxygen. The haemodynamic effect, perioperative complications and recovery profiles were recorded. Systolic arterial pressure and heart rate decreased after induction of anaesthesia but returned to baseline value at discharge. Adverse airway event such as coughing and postoperative nausea and vomiting are two unwanted complications. KEYWORDS: Desflurane, day surgery, propofol induction

Matched MeSH terms: Medical Audit
Fulltext Demographic characteristics and prevalence of other sexually transmitted diseases in HIV-positive patients seen in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah, Johor Bahru

Choon SE, Mathew M, Othman BS

Med J Malaysia, 2000 Jun;55(2):174-9.
PMID: 19839145

The demographic characteristics, risk behaviourand prevalence of other sexually transmitted diseases (STDs) were determined in 132 HIV-infected individuals seen in a Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru. Sixty-one (46.2%) were Malays, 37.9% Chinese, 10.6% Indians and 5.3% were of other ethnic groups. The male to female ratio was 4.5:1. Most of the patients (82.5%) were between 20 to 40 years-old. Seventy (53.0%) were single, 34.1% were married and 7.5% were divorcees. The majority of them (97.7%) were heterosexual. Fifty seven (53.3%) of our male patients patronised commercial workers. Eighty-one (61.8%) were not intravenous drug users (IVDU). Of the 50 IVDUs, 24 had multiple sexual exposures. Fifty-three (48.2%) of the 109 patients screened for STDs had one or more other STDs. Thirty-four patients (31.9%) reported one STD in the past and 3.6% reported two STDs in the past. Fifty-six patients (42.4%) had developed AIDS. Thirteen had passed away. The main mode of transmission of HIV infection in this population is through heterosexual intercourse and the prevalence of STDs is high. These findings indicate a need to advocate responsible sexual behaviour and to detect as well as treat STDs early to prevent the sexual transmission of HIV.

Study site: Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru

Matched MeSH terms: Medical Audit
Fulltext Audit of perioperative blood transfusion

Choy YC, Lim WL, Ng SH

Med J Malaysia, 2007 Oct;62(4):299-302.
PMID: 18551933 MyJurnal

The main goal of perioperative transfusion is to reduce the morbidity and mortality associated with inadequate delivery of oxygen to the tissues during surgery. In this audit, the primary trigger for transfusion was clinical anaemia assessed by examination of a patient's conjunctiva [40.7%] followed by estimation of blood loss of greater 20% of total blood volume [29.3%]. Haemoglobin estimation in the operation theater was not done in 45.9% of studied patients and only 7.8% patients had transfusion based on this criteria. A common practice is to transfuse blood for hypovolaemia. This was the indication for blood transfusion in 96 patients (7.8%). Inappropriate use of blood in this way has led to wastage of a valuable resource and exposed patients to potential risks of unwanted side effects. Analysis of haemoglobin estimation at recovery room showed 32% of patient with co-morbidities had Hb > 10 gm% while 65% and 29.5% of patients without co-morbidities had Hb > 8 gm% and 10 gm% respectively. This reflects the practice of anaesthetists in maintaining a target of Hb of 10 gm% for both groups of patients while a target of 8 gm% is still relatively safe for patients with good cardiovascular reserves. This has resulted in signifant use of homologous blood which will certainly burden the blood bank and increase the cost of healthcare.

Matched MeSH terms: Medical Audit
Fulltext An audit of the Scoliosis Service at Hospital Kuala Lumpur

Chuah SL, Kareem BA, Selvakumar K, Oh KS, Borhan Tan A, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:31-6.
PMID: 11814246 MyJurnal

This is a study of patients referred to the Scoliosis Service of Hospital Kuala Lumpur. Three hundred and thirty five (335) consecutive patients who were seen between 1985 and 2000 were reviewed to determine the presentation of scoliosis, the treatment received and the compliance to follow up. Data were determined by measuring the frontal spinal radiographs. Two hundred and ninety eight (298) patients met inclusion criteria. Idiopathic scoliosis accounted for 203 patients (68.1%), 31 (10.4%) were neuromuscular scoliosis; and 44 (14.8%) had congenital scoliosis. Twenty-five point five percent of patients had surgery, 10.4% were treated with brace, while the remaining 69.1% of patients were observed, or had no treatment at all. Congenital scoliosis patients had better compliance compared to idiopathic or neuromuscular scoliosis patients.

Matched MeSH terms: Medical Audit*
Medical audit. A method of assessing hospital efficiency

Dugdale AE

Med J Aust, 1970 Dec 5;2(23):1087-91.
PMID: 5491085
Matched MeSH terms: Medical Audit*
Fulltext Audit of pain management in the emergency department

Fathil SM, Soong NS, Mustafa NM, Arith A, Ng WN, Bahrum NA, et al.

Med J Malaysia, 2011 Jun;66(2):89-91.
PMID: 22106683 MyJurnal

Pain management in Malaysian Emergency Departments has not been studied well. Convenience sampling was used to recruit 402 patients who presented with acute pain over a 2-week period. The 11-point Numerical Rating Scale was used to quantify pain. Pain relieving medications were prescribed to 178 patients (44.3%) in the Emergency Department. These patients had a median pain score of 7 on arrival. Nonsteroidal anti inflammatory drugs were the most commonly prescribed class of analgesic. Pain was found to be inadequately treated.

Matched MeSH terms: Medical Audit
Fulltext Endoscopic-assisted craniofacial resection: a case series and post-operative outcome

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: Medical Audit
The use of medical audit to improve the care of high risk deliveries

Hamzah-Sendut, I., Tee, Ah Chuan

Malaysian Journal of Child Health, 1992;4(1):13-15.
MyJurnal

A medical audit is defined as a systematic and critical analysis carried out by doctors looking at the things that doctors do. The concept of auditing is relatively new to the medical profession. It is indeed an excellent instrument to institute change to medical practices which have been "institutionalized". A properly carried out audit can provide highly revealing data that can often sway an administrator to institute change. At the University Hospital Kuala Lumpur we chose to audit the paediatric attendances at high risk deliveries. High risk deliveries were defined as any delivery to which the obstetrician requested a paediatric attendance prior to delivery. A paediatrician must be on hand at all high risk deliveries to ensure proper resuscitation of the new born. The aim of the audit was to determine if paediatric attendance at high risk deliveries were optimal at the University Hospital. (Copied from article).

Matched MeSH terms: Medical Audit
Fulltext Continuity of care of diabetic patients in a family practice clinic: How important is it?

Hanafi NS, Teng CL, Yasin S

Asia Pac Fam Med, 2003;2(1):10-15.

Aim: To assess the importance of continuity of care among diabetic patients attending a primary care clinic and to correlate degree of continuity of care with diabetic control. Methods: A cross sectional survey was carried out among diabetic patients (n = 166) attending follow-up consultations in a family practice clinic of a teaching hospital. Face-to-face interviews were carried out on patients' perception of continuity of care and various aspects related to diabetes. Diabetic control was assessed by glycosylated hemoglobin. Retrospective chart audits of each patient over the previous 28 months were done to assess the degree of continuity of care, measured with the Usual Provider Continuity Index (UPCI). Results: The UPCI ranged from 0.18 to 1.00 with a mean value of 0.60. The average number of visits per patient over the 28-month period was 11.7 visits. The majority of patients saw five different doctors for all their visits. There were no statistically significant associations between the degree of provider continuity with diabetic control (r = 0.054) and diabetic self-care behavior (r = 0.065). The majority of patients (89%) felt that it was important to have a regular doctor. The main reason given was that a regular doctor would know the patient's problems. Conclusions: Continuity of care was highly valued by diabetic patients attending a hospital-based family practice clinic. Even though the degree of continuity was not associated with the degree of diabetic control, patients felt that it was important to have doctors who are aware of their problems.

Matched MeSH terms: Medical Audit
Fulltext Global childhood unintentional injury study: multisite surveillance data

He S, Lunnen JC, Puvanachandra P, Amar-Singh, Zia N, Hyder AA

Am J Public Health, 2014 Mar;104(3):e79-84.
PMID: 24432924 DOI: 10.2105/AJPH.2013.301607

We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan).

Matched MeSH terms: Medical Audit
Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy

Ho YL, Fauzi M, Sothee K, Basheer A

Med J Malaysia, 2020 09;75(5):555-560.
PMID: 32918426

INTRODUCTION: Hyperhidrosis is a disorder of excessive and uncontrollable sweating beyond the body's physiological needs. It can be categorised into primary or secondary hyperhidrosis based on its aetiology. Detailed history review including onset of symptoms, laterality of disease and family history are crucial which may suggest primary hyperhidrosis. Secondary causes such as neurological diseases, endocrine disorders, haematological malignancies, neuroendocrine tumours and drugs should be adequately examined and investigated prior to deciding on further management. The diagnosis of primary hyperhidrosis should only be made only after excluding secondary causes. Hyperhidrosis is a troublesome disorder that often results in social, professional, and psychological distress in sufferers. It remains, however, a treatment dilemma among some healthcare providers in this region.
METHODS: The medical records and clinical outcomes of 35 patients who underwent endoscopic thoracic sympathectomy for primary hyperhidrosis from 2008 to 2018 in Department of Cardiothoracic Surgery were reviewed.
RESULTS: The mean age of the patients was 27±10.1years, with male and female distribution of 18 and 17, respectively. Fifty-one percent of patients complained of palmar hyperhidrosis, while 35% of them had concurrent palmaraxillary and 14% had palmar-plantar-axillary hyperhidrosis. Our data showed that 77% (n=27) of patients were not investigated for secondary causes of hyperhidrosis, and they were not counselled on the non-surgical therapies. All patients underwent single-staged bilateral endoscopic thoracic sympathectomy. There was resolution of symptoms in all 35 (100%) patients with palmar hyperhidrosis, 13(76%) patients with axillary hyperhidrosis and only 2 (50%) patients with plantar hyperhidrosis. Postoperatively 34.3% (n=12) of patients reported compensatory hyperhidrosis. There were no other complications such as pneumothorax, chylothorax, haemothorax and Horner's Syndrome.
CONCLUSION: Clinical evaluation of hyperhidrosis in local context has not been well described, which may inadvertently result in the delay of appropriate management, causing significant social and emotional embarrassment and impair the quality of life of the subjects. Detailed clinical assessment and appropriate timely treatment, be it surgical or non-surgical therapies, are crucial in managing this uncommon yet distressing disease.

Matched MeSH terms: Medical Audit
Fulltext A hospital based audit of tuberculosis deaths

Hooi LN, Goh KY

Med J Malaysia, 1995 Dec;50(4):306-13.
PMID: 8668048

An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.

Matched MeSH terms: Medical Audit
A study of the appropriateness of antibiotic use in the medical wards of a tertiary teaching hospital in Malaysia

Hooi PY, Yong CM, Cheong I

Int J Clin Pract, 2001 May;55(4):272-4.
PMID: 11406914

A prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four-week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22-65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.

Matched MeSH terms: Medical Audit
Fulltext A review of dengue fever incidence in Kota Bharu, Kelantan, Malaysia during the years 1998-2003

Hussin N, Jaafar J, Naing NN, Mat HA, Muhamad AH, Mamat MN

Southeast Asian J. Trop. Med. Public Health, 2005 Sep;36(5):1179-86.
PMID: 16438143

Dengue is the most common and widespread arthropod borne arboviral infection in the world today. It is estimated that there are at least 100 million cases of dengue fever (DF) annually and 500,000 cases of dengue hemorrhagic fever (DHF) which require hospitalization. In Malaysia, it has become a major public health problem. Malaysia recorded 19,544 dengue cases in 1997, the highest recorded since the disease was made notifiable in the country. Of 19,544 cases, 806 were DHF with 50 deaths. The objectives of this analysis were to describe the incidence of dengue fever and dengue hemorrhagic fever in Kota Bharu, Kelantan, Malaysia for the years 1998-2003 and to explore the characteristics of dengue fever and dengue hemorrhagic fever in Kota Bharu, Kelantan, Malaysia for years 1998-2003. A total of 4,716 dengue cases were notified involving 4,476 (94.9%) DF and 240 (5.1%) DHF cases, which increased though the years. The highest incidence was in January (701 or 14.9%), while the lowest was in May (188 or 4.0%). Forty percent of cases (n=1,890) were in the 15-29 year old group. The Majority were Malays (4,062 or 86.1%) and 2,602 or 55.2% were male. A total of 4,477 cases (95%) were local cases and 4,289 or 91% came from the urban area. For priority areas, 3,772 (80%) were from priority 1. More than half the cases had positive serology results. All symptoms occurred in more than 96% of cases and fever was the commonest (99.7%). The mean values for age, temperature, systolic and diastolic blood pressure (BP) were 27.8 +/- 15.4 years, 37.9 +/- 0.90 degrees C, 115 +/- 15.2 mmHg and 73 +/- 11.1 mmHg, respectively. The mean value for the time interval between the onset of symptoms and diagnosis, onset of symptoms and notification and time of diagnosis to notification were 5.1 +/- 2.3, 5.9 +/- 2.5 and 0.8 +/- 1.1 days, respectively. There were associations between the types of dengue and classification, area and priority area. Among the symptoms, the association was only seen in joint pain. The mean significant differences between DF and DHF were found in age and systolic blood pressure. The incidence of dengue in Kota Bharu is comparable to that in Malaysia. The increase in the number of cases needs to be addressed promptly with effective surveillance, prevention and control programs.

Matched MeSH terms: Medical Audit
Fulltext An audit of parotidectomy in Singapore: a review of 31 cases

Hwang SY, Brett RH

Med J Malaysia, 2003 Jun;58(2):273-8.
PMID: 14569749

A series of 31 consecutive parotidectomies was evaluated. FNAC could differentiate tumour from non tumour in 72.8% of cases. For actual histology, FNAC was correct in 66.6%. Frozen section was correct in differentiating between benign, malignant and inflammatory conditions in all cases. Eighty-eight percent of frozen section histology concurred with final histology. The immediate postoperative period had 13 cases of facial nerve dysfunction, but only 3 cases had residual weakness. The branch most commonly affected was the mandibular branch (92.3%). Two patients had Frey's syndrome and one had a traumatic neuroma. FNAC and CT scans improve preoperative planning, providing histological evidence and the extent of the lesion.

Matched MeSH terms: Medical Audit*
Fulltext A 2-year audit of perioperative mortality in Malaysian hospitals

Inbasegaran K, Kandasami P, Sivalingam N

Med J Malaysia, 1998 Dec;53(4):334-42.
PMID: 10971975

An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.

Matched MeSH terms: Medical Audit*
Fulltext Quality of Diabetes Care at MOH Healthcare Facilities: SIQ Investigation Guideline, Fifth Edition

Ismail F

ISBN: 978-983-3433-58-2

Citation: Quality of Diabetes Care at MOH Healthcare Facilities: SIQ Investigation Guideline, Fifth Edition. Putrajaya: Ministry of Health, Malaysia; 2011

Matched MeSH terms: Medical Audit
Fulltext Diabetes Registry Malaysia: report of an audit of diabetes control and management (January-December 2009)

Ismail M, Haniff J, Wan Bebakar WM

Citation: Ismail M, Haniff J, Wan Bebakar WM. Diabetes Registry Malaysia: report of an audit of diabetes control and management (January-December 2009). Kuala Lumpur: Clinical Research Centre, 2010

Matched MeSH terms: Medical Audit

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