Displaying publications 21 - 40 of 110 in total

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  1. Fulltext An audit of the quality of lateral cephalometric radiographs for orthodontic treatment
    Mohd Zambri Mohamed Makhbul, Rashidah Burhanudin, Wan Nurazreena Wan Hassan
    Malaysian Dental Journal, 2016;39(1):35-51.
    MyJurnal
    It is not uncommon for lateral cephalometric radiographs to be outsourced for orthodontic treatment, as not all orthodontic clinics in Malaysia have their own cephalometric radiograph machine. Since the quality of outsourced radiographs is not within the governance of the clinician, there is a need to monitor the quality of cephalometric radiographs received. Aim: To audit the quality of lateral cephalometric radiographs received at the Orthodontic Specialist Unit, Klinik Pergigian Cahaya Suria, Kuala Lumpur, Malaysia. Methodology: Lateral cephalometric records of patients with registration numbers up to 200 in 2015 were selected and assessed using a light box. The quality of good radiographs were based on 15 parameters: correct head position; presence of the scale; important structures centered on the film; patient’s name; date taken; patient’s identifier; label not obscuring radiograph; soft tissue visible; teeth in occlusion; good contrast; ‘A’ point identifiable; ‘B’ point identifiable; nasion identifiable; sella identifiable; incisors visible and their angulation measureable. Standard was set at 100%, as radiographs received should contain all parameters. Results: Five records were excluded (2 had no radiographs, 2 had digital radiographs, and 1 record could not be traced). 64.5% radiographs had all 15 parameters, 30.3%, 3.9% and 1.3% with 14, 13 and 12 parameters, respectively. Patient’s name, identifier, date taken, soft tissue visible, ‘B’ point identifiable, nasion identifiable were present in all radiographs (100%). Incisor visible and their angulation measurable were present in 99%; good contrast and ‘A’ point identifiable in 98%; presence of scale, important structures centred on films and sella identifiable in 97%, label not obscuring radiographs in 96%; correct head position in 86%; and teeth in occlusion in 88% of radiographs. Conclusion: There is a need to liaise with the radiology unit to improve the quality of radiographs taken.
    Matched MeSH terms: Medical Audit*
  2. Fulltext Reduction of intubation rate during newborn resuscitation after transition from self-inflating bag to T-piece resuscitator
    Ng KF, Choo P, Paramasivam U, Soelar SA
    Med J Malaysia, 2015 Aug;70(4):228-31.
    PMID: 26358019
    INTRODUCTION: T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate.
    METHODS: We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn <24 hours of life was deemed high if >50%. An audit was carried out in June 2010 to verify this problem using a check sheet.
    RESULTS: 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies <24 hours of life when SIB was used was 68%. Post-intervention audit (August to November 2010) on 25 newborns showed that the intubation rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced.
    CONCLUSION: This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.
    Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Medical Audit
  3. Fulltext Audit on management of eclampsia at Sultan Abdul Halim Hospital
    Mohd Azri MS, Edahayati AT, Kunasegaran K
    Med J Malaysia, 2015 Jun;70(3):142-7.
    PMID: 26248775 MyJurnal
    INTRODUCTION: Maternal mortality and morbidity from eclampsia continues to be seen around the globe. Local Key Performance Index on recurrence of eclamptic fits did not meet targets, thus this raised the issue whether the care provided adhered to the standard management for eclampsia.

    METHODS: This clinical audit was conducted to assess and improve the quality of the service being offered to patient, particularly in managing eclampsia cases. It was conducted according to the audit cycle. It begins with the development of 12 standardized criteria for eclampsia management. First audit was conducted by retrospectively reviewing eclampsia cases from year 2008 till 2012. Strategies for changes were formulated and implemented following the results of the first audit. Second audit was conducted six months after the changes.

    RESULTS: The overall incidence rate of eclampsia was 9.17 per 10,000 deliveries. A first seizure occurred during the antepartum period in 52.9% of cases (n=27), intrapartum in 24% (n=11) and postpartum in 21% of cases (n=13). Suboptimal care was mainly on delay of activation of Red Alert system and no treatment for uncontrolled blood pressure. Several strategies were implemented, mainly on improving working knowledge of the staffs and reengineering hospital Red Alert system. Positive achievements observed during the second audit, shown by a reduction in the number of patients with recurrence eclamptic fits and perinatal mortality rate.

    CONCLUSION: Conducting an audit is essential to evaluate local performance against the standardized criteria. Improvement can be achieved with inexpensive solutions and attainable within a short period of time.
    Study site: Sultan Abdul Halim Hospital, Sungai Petani, Kedah, Malaysia
    Matched MeSH terms: Medical Audit*
  4. Fulltext Healthcare Databases in Thailand and Japan: Potential Sources for Health Technology Assessment Research
    Saokaew S, Sugimoto T, Kamae I, Pratoomsoot C, Chaiyakunapruk N
    PLoS One, 2015;10(11):e0141993.
    PMID: 26560127 DOI: 10.1371/journal.pone.0141993
    Health technology assessment (HTA) has been continuously used for value-based healthcare decisions over the last decade. Healthcare databases represent an important source of information for HTA, which has seen a surge in use in Western countries. Although HTA agencies have been established in Asia-Pacific region, application and understanding of healthcare databases for HTA is rather limited. Thus, we reviewed existing databases to assess their potential for HTA in Thailand where HTA has been used officially and Japan where HTA is going to be officially introduced.
    Matched MeSH terms: Medical Audit/methods; Medical Audit/statistics & numerical data
  5. Fulltext Management of pulmonary tuberculosis in health clinics in the Gombak district: How are we doing so far?
    Ariffin F, Ahmad Zubaidi AZ, Md Yasin M, Ishak R
    Malays Fam Physician, 2015;10(1):26-33.
    PMID: 26425292 MyJurnal
    This audit report assessed the structure, processes and outcome of the pulmonary tuberculosis (PTB) management in adults conducted at eight government health clinics within the high TB burden Gombak district. All newly diagnosed PTB patients from November 2012 to November 2013 were identified from the tuberculosis registry. Patients less than 18 years old, were transferred out or extrapulmonary tuberculosis was excluded from the study. The assessment criteria for PTB were defined according to the latest Malaysian TB clinical practice guidelines (TB CPG) 2012. A total of 117 patients were included in this report and data were extracted and analysed using SPSS version 20.0. The mean age of patients was 40.4 ± 14.4 SD. Majority was men (63.2%). Out of 117 patients, 82.1% were Malaysian citizens and 17.9% were foreigners. Malays were the majority (65%) followed by 7.7% Chinese, 10.3% Indian and 17.1% others. The most common clinical feature was cough (88.0%) followed by loss of weight (58.1%), loss of appetite (57.3%), fever (56.4%), night sweat (30.8%) and haemoptysis (32.5%). Acid-fast bacilli (AFB) smear was positive in 94% of cases. Chest X-ray and human immunodeficiency virus (HIV) screening results were available for 89.1 and 82.1% cases respectively. The results for the sputum culture were available in 27.4% of patients and 54.7% were documented as done but pending results. The clinics have a successful directly observed therapy (DOT) program with 94.0% patients documented under DOT. Out of 53 patients on maintenance phase, 47.2% were identified as cured. Cure rate for those completed treatment was 100%. The defaulter rate was 17.1%. This audit demonstrated the attempt made by the clinics to adhere to the recommended guidelines. However, improvements are to be made in the documentation of medical records, tracing of investigation results and reduction of the number of defaulters.
    Matched MeSH terms: Medical Audit
  6. 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
  7. Fulltext Lessons from the confidential enquiry into maternal deaths, Malaysia
    Ravichandran J, Ravindran J
    BJOG, 2014 Sep;121 Suppl 4:47-52.
    PMID: 25236633 DOI: 10.1111/1471-0528.12944
    Malaysia has successfully reduced maternal mortality through several efforts which, in the broad sense, include (i) the overall socio-economic development of the country; (ii) strengthened health services; and (iii) specific efforts and initiatives for the reduction of maternal mortality, one of which is the audit of maternal deaths by the confidential enquiry into maternal deaths.
    Matched MeSH terms: Medical Audit
  8. Fulltext Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia
    Atif M, Sulaiman SA, Shafie AA, Asif M, Babar ZU
    BMC Health Serv Res, 2014 Aug 19;14:353.
    PMID: 25138659 DOI: 10.1186/1472-6963-14-353
    BACKGROUND: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.
    METHODS: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).
    RESULTS: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.
    CONCLUSION: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.
    Study site: Chest clinic, Hospital Pulau Pinang, Malaysia
    Matched MeSH terms: Medical Audit
  9. 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
  10. Fulltext Type 2 Diabetes Mellitus Patient Profiles, Diseases Control and Complications at Four Public Health Facilities- A Cross-sectional Study based on the Adult Diabetes Control and Management (ADCM) Registry 2009
    Chew BH, Shariff-Ghazali S, Lee PY, Cheong AT, Mastura I, Haniff J, et al.
    Med J Malaysia, 2013 Oct;68(5):397-404.
    PMID: 24632869 MyJurnal
    INTRODUCTION: Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia.
    MATERIALS AND METHODS: This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses.
    RESULTS: The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L.
    CONCLUSION: Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians.
    Matched MeSH terms: Medical Audit*
  11. Fulltext Indications and outcome of anti-phospholipid syndrome testing in an obstetric population at Sabah Women & Children Hospital, Kota Kinabalu, Sabah, Borneo Malaysia
    Valayatham V
    Med J Malaysia, 2012 Aug;67(4):399-401.
    PMID: 23082449 MyJurnal
    AIM: We audited indications and outcomes of antiphospholipid syndrome (APS) screening in the pregnant population at our centre.
    METHOD: Prospective and observational. All APS test results returned were audited for validity of indication and subsequent outcome.
    RESULT: 24 of a total of 146 (16%) of requests for the antiphospholipid antibodies and lupus anticoagulant were not indicated. Two positive results returned for a total of 116 "indicated" requests (1.7%).
    CONCLUSION: There needs to be increased awareness among obstetricians on the indications for screening for antiphospholipid syndrome (APS). The prevalence of antiphospholipid syndrome with obstetric manefestations in the study population is lower than rates published in the literature.
    Matched MeSH terms: Medical Audit
  12. Fulltext An annual audit of the ear foreign bodies in Hospital Universiti Sains Malaysia
    Yaroko AA, Irfan M
    Malays Fam Physician, 2012;7(1):2-5.
    PMID: 25606237 MyJurnal
    Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

    Study site: torhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM)
    Matched MeSH terms: Medical Audit
  13. Fulltext An audit of sputum smear negative pulmonary tuberculosis cases in Kinta district, Perak, in 2011
    Subashini A, Lau KM, Habibur Rahman ZA
    Malays Fam Physician, 2012;7(2-3):31-4.
    PMID: 25606253 MyJurnal
    58 cases of sputum smear negative pulmonary tuberculosis (PTB) were reported to Kinta Health Department between January and June 2011. It was found that 47 cases (81%) were sputum smear negative cases. Six cases (10.3%) were actually sputum smear positive but were wrongly reported as smear negative. Five cases (8.6%) were misdiagnosed as tuberculosis. Majority of these patients (82.7%) sought consultation and treatment after two weeks of having cough. Only 6.9% sought treatment for cough that was less than two weeks old. Accurate diagnosis of PTB is crucial and the Perak State Health Department needs to quickly adopt steps to improve the situation.
    Matched MeSH terms: Medical Audit*
  14. Fulltext An audit of type 2 diabetes care in a Malaysian public community polyclinic
    Chew BH, Palikat JM, Nur Syamimi A, Nor Azillah A, See JK, Hafiz AR, et al.
    Pertanika Journal of Science & Technology, 2012;20(1):97-102.
    MyJurnal
    Adequate and proper diabetes care in any practice is paramount and deems to be the fundamental requirement for good diabetes control. This is an audit of type 2 diabetes care process in a public Polyclinic, with the objectives of studying the quality of diabetic care provided in terms of clinical and managerial performance and also to give recommendations on improving its diabetes care delivery. The audit was done on patients' medical records selected via systematic random sampling. Patients who have been diagnosed with type 2 diabetes mellitus for more than 2 years, and those who have come for follow-up at least twice in between 1st October 2008 and 30th September 2009 by the medical officer and/or family medicine specialist. Patients with gestational diabetes mellitus and Type 1 diabetes mellitus were excluded. A total of 100 medical records were audited. 51% were female and 82% were in the 40-69 age group. Measurements of blood glucose and blood pressure were done at each follow-up at the polyclinic at 96% and 93% of the times, respectively. Within the past one year, HbA1c was performed in 46% of the patients, while renal profile was screened in 66% of the patients and urine protein was tested in 59% of the diabetics. Only 15% had their eyes screened by fundus camera. The diabetes care process at this public polyclinic was unsatisfactory, as many annual blood tests were not done and complications screening were also omitted. Thus, an urgent intervention is recommend in order to rectify these inadequacies.
    Matched MeSH terms: Medical Audit
  15. Fulltext An audit of reported acute transfusion reactions in Universiti Kebangsaan Malaysia Medical Centre
    Rabeya Y, Abdul-Kahar AH, Leong CF
    Malays J Pathol, 2011 Jun;33(1):25-9.
    PMID: 21874748 MyJurnal
    Transfusion is an irreversible event which carries potential benefits as well as risk to the recipient. The objective of this study was to analyse all reported transfusion reactions of the year 2008 in the Blood Bank Unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This is a retrospective study that was carried out by retrieving data from the laboratory information system. A total of 27842 transfusions were documented and the total reported transfusion reactions were 149. The incidence of transfusion reaction was 1 in 187 of all transfusions (0.54%); in which 69 (0.25%) were allergic in nature and 61 (0.22%) were febrile non-haemolytic transfusion reactions (FNHTR). Hypotensive reactions were identified in 6 (0.02%) patients. There were 9 (0.03%) cases reported with haemoglobinuria where no serological evidence of haemolytic transfusion reaction (HTR) was found. One HTR (0.003%) was identified and this was due to an error in patient identification in the ward. Other specified reactions like transfusion-related acute lung injury (TRALI), bacterial infections, Graft verses host disease (GVHD) were not reported. The highest frequency of the reactions occurred in the red cell transfusions which accounted for 111 cases. In conclusion, the incidences of transfusion reactions are low when compared to those reported by other centres.
    Matched MeSH terms: Medical Audit
  16. 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
  17. Improving diabetes care in a public hospital medical clinic: report of a completed audit cycle
    Tan F, Liew SF, Chan G, Toh V, Wong SY
    J Eval Clin Pract, 2011 Feb;17(1):40-4.
    PMID: 20807297 DOI: 10.1111/j.1365-2753.2010.01367.x
    RATIONALE, AIMS AND OBJECTIVES: To evaluate the impact of clinical audit on diabetes care provided to type 2 diabetic patients attending our hospital general medical clinics.
    METHODS: Performances on diabetes-related process measures and intermediate outcome measures were evaluated through structured review of outpatient medical records. The results were fed back to the doctors and measures were implemented to improve care. The performance indicators were re-evaluated 2 years later to complete the audit cycle.
    RESULTS: Annual testing rates improved for HbA1c (68.4% vs. 87.4%; P < 0.001) and lipid profile (91.8% vs. 97%; P = 0.027). Enquiry on smoking improved from 45.9% to 82.3% (P < 0.001), eye screening rates from 68.9% to 78.8% (P = 0.020) and foot examinations from 22.4% to 64.1% (P < 0.001). Prescription rates for insulin increased from 17.3% to 31.8% (P = 0.001) and statin from 83.2% to 94.4% (P < 0.001). The use of aspirin (80.6% vs. 83.8%; P =0.402) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (92.3% vs. 88.9%; P = 0.239) remained high in both cycles. More patients achieved targets for HbA1c < 7% (38% vs. 26%; P = 0.006), blood pressure < 130/80 mmHg (43% vs. 32%; P = 0.071) and low-density lipoprotein cholesterol < 2.6 mmol/L (71% vs. 52%; P <0.001).
    CONCLUSION: Clinical audit is a useful tool in improving diabetes care.
    Study site: Outpatient clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
    Matched MeSH terms: Medical Audit*
  18. Fulltext An audit of bronchial asthma control at a primary public health care facility
    Usha Devi B, Hairul Izwan AR, Munjeet KPS, Rosidah CP
    Malaysian Journal of Public Health Medicine, 2011;11(2):22-26.
    MyJurnal
    A study was conducted at Greentown Health Clinic, Ipoh to assess and classify asthma by levels of control based on the Global Initiative for Asthma (GINA). The secondary objective was to identify those patients whose control was suboptimal. A total of 102 patients were included in this study based on random sampling between 25th April 2008 and 6th June 2008. Standard Asthma Control Questionnaires were used to classify asthma and levels of control. Baseline Peak Expiratory Flow Rate (PEFR) measurements and PEFR at audit visits were also recorded. All data were analysed using SPSS version 13. The study showed that only 39.2 % of the patients were classified as having controlled asthma, 34.3 % had asthma that was partly controlled and 26.5 % of the patients had uncontrolled asthma. Among those patients who had inadequate asthma control, more than half of them had nocturnal attacks and exacerbations. These findings demonstrate the need by the attending doctor to improve assessment of the patient’s control of asthma by actively questioning the patients and subsequently improving management to achieve optimal control of asthma.
    Study site: Klinik Kesihatan Greentown, Ipoh, Perak, Malaysia
    Matched MeSH terms: Medical Audit*
  19. Influenza B outbreak among influenza-vaccinated welfare home residents in Singapore
    Win MK, Chow A, Chen M, Lau YF, Ooi EE, Leo YS
    Ann Acad Med Singap, 2010 Jun;39(6):448-52.
    PMID: 20625620
    INTRODUCTION: Outbreaks of acute respiratory illness occur commonly in long-term care facilities (LTCF), due to the close proximity of residents. Most influenza outbreak reports have been from temperate countries. This study reports an outbreak of influenza B among a highly immunised resident population in a welfare home in tropical Singapore, and discusses vaccine efficacy and the role of acute respiratory illness surveillance for outbreak prevention and control.

    MATERIALS AND METHODS: During the period from 16 to 21 March 2007, outbreak investigations and active case finding were carried out among residents and nursing staff at the welfare home. Interviews and medical notes review were conducted to obtain epidemiological and clinical data. Hospitalised patients were tested for respiratory pathogens. Further genetic studies were also carried out on positive respiratory samples.

    RESULTS: The overall clinical attack rate was 9.4% (17/180) in residents and 6.7% (2/30) in staff. All infected residents and staff had received influenza immunisation. Fifteen residents were hospitalised, with 2 developing severe complications. Genetic sequencing revealed that the outbreak strain had an 8.2% amino acid difference from B/Malaysia/2506/2004, the 2006 southern hemisphere influenza vaccine strain, which the residents and staff had earlier received.

    CONCLUSIONS: A mismatch between the vaccine and circulating influenza virus strains can result in an outbreak in a highly immunised LTCF resident population. Active surveillance for acute respiratory illness in LTCFs could be implemented for rapid detection of antigenic drift. Enhanced infection control and other preventive measures can then be deployed in a timely manner to mitigate the effect of any outbreaks.

    Matched MeSH terms: Medical Audit
  20. Fulltext A clinical audit on diabetes care in two urban public primary care clinics in Malaysia
    Sazlina SG, Zailinawati AH, Zaiton A, Ong I
    Malaysian Journal of Medicine and Health Sciences, 2010;6(1):101-109.
    MyJurnal
    Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year. Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5 %. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6 mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was
    found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour.
    Matched MeSH terms: Medical Audit*
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