Displaying publications 21 - 40 of 806 in total

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  1. Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F
    Singapore Med J, 2006 Sep;47(9):763-8.
    PMID: 16924357
    Introduction: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants.
    Methods: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy.
    Results: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors.
    Conclusion: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.
    Matched MeSH terms: Risk Assessment
  2. Sakai N, Shirasaka J, Matsui Y, Ramli MR, Yoshida K, Ali Mohd M, et al.
    Chemosphere, 2017 Apr;172:234-241.
    PMID: 28081507 DOI: 10.1016/j.chemosphere.2016.12.139
    Five homologs (C10-C14) of linear alkylbenzene sulfonate (LAS) were quantitated in surface water collected in the Langat and Selangor River basins using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A geographic information system (GIS) was used to spatially analyze the occurrence of LAS in both river basins, and the LAS contamination associated with the population was elucidated by spatial analysis at a sub-basin level. The LAS concentrations in the dissolved phase (<0.45 μm) and 4 fractions separated by particle size (<0.1 μm, 0.1-1 μm, 1-11 μm and >11 μm) were analyzed to elucidate the environmental fate of LAS in the study area. The environmental risks of the observed LAS concentration were assessed based on predicted no effect concentration (PNEC) normalized by a quantitative structure-activity relationship model. The LAS contamination mainly occurred from a few populated sub-basins, and it was correlated with the population density and ammonia nitrogen. The dissolved phase was less than 20% in high contamination sites (>1000 μg/L), whereas it was more than 60% in less contaminated sites (<100 μg/L). The environmental fate of LAS in the study area was primarily subject to the adsorption to suspended solids rather than biodegradation because the LAS homologs, particularly in longer alkyl chain lengths, were considerably absorbed to the large size fraction (>11 μm) that settled in a few hours. The observed LAS concentrations exceeded the normalized PNEC at 3 sites, and environmental risk areas and susceptible areas to the LAS contamination were spatially identified based on their catchment areas.
    Matched MeSH terms: Risk Assessment
  3. Ghani Z, Anuar A, Majid Z, Yoneda M
    Sains Malaysiana, 2017;46:2383-2392.
    This study describes the development of a multimedia environmental fate and transport model of dichlorodiphenyltrichloroethane (DDT) at Sungai Sayong watershed. Based on the latest estimated DDT emission, the DDT concentrations in air, soil, water and sediment as well as the transfer processes were simulated under the equilibrium and steady-state assumption. Model predictions suggested that soil and sediment was the dominant sink of DDT. The results showed that the model predicted was generally good agreement with field data. Compared with degradation reaction, advection outflow was more important processes occurred in the model. Sensitivities of the model estimates to input parameters were tested. The result showed that vapour pressure (Ps) and organic carbon water partition coefficient (KOC) were the most influential parameters for the model output. The model output-concentrations of DDT in multimedia environment is very important as it can be used in future for human exposure and risk assessment of organochlorine pesticides (OCPs) at Sungai Sayong Basin.
    Matched MeSH terms: Risk Assessment
  4. Velaiutham S, Taib NA, Ng KL, Yoong BK, Yip CH
    Asian Pac J Cancer Prev, 2008 Jul-Sep;9(3):445-8.
    PMID: 18990019
    INTRODUCTION: CA15-3 is a well-known tumour marker for breast cancer. Currently it is not recommended for screening or diagnosis of breast cancer and its main application is in monitoring response to treatment in women with metastatic breast cancer. The aim of this study was to correlate serum CA15-3 at presentation with the stage of disease and overall survival in women with breast cancer in the University Malaya Medical Centre.

    METHODS: This is a retrospective study of 437 women who had CA15-3 levels determined at initial presentation of breast cancer to UMMC between Jan 1999 and Oct 2003.

    RESULTS: Of those patients who were adequately staged, CA15-3 was found to be elevated (defined as >51 U/ml) in 0% of Stage 1, 7.9% of Stage 2, 36.7% of Stage 3 and 68.6% of Stage 4 cases. In a subset of 331 patients with survival data, patients with normal CA15-3 had a 85% five year overall survival rate compared to 38% in their counterparts with elevation of the tumor marker. The level of elevation was also significantly related to survival; patients with values more than 200 U/ml exhibited only a 28% five year survival. The association of elevated CA15-3 at initial presentation with poor outcome was maintained over univariate and multivariate analyses.

    CONCLUSION: Estimation of CA15-3 at presentation of breast cancer is important as it is an independent prognostic indicator and may prompt the physician to investigate for metastases if elevated.
    Matched MeSH terms: Risk Assessment
  5. Aris A, Khalid MZM, Yahaya H, Yoong LO, Ying NQ
    Curr Diabetes Rev, 2020;16(4):387-394.
    PMID: 31433762 DOI: 10.2174/1573399815666190712192527
    BACKGROUND: Type 2 diabetes (T2D) is a preventable condition. Targeting those who are at risk of getting this disease is essential.

    OBJECTIVE: To examine T2D risk among university students in Malaysia and determine its relationship with socio-demographic characteristics and physical activity.

    METHODS: The study was conducted cross-sectionally on 390 students selected using quota sampling method from 13 faculties in Universiti Kebangsaan Malaysia. A short form of the International Physical Activity Questionnaire and Finnish Diabetes Risk Score were used to measure the physical activity and T2D risk.

    RESULTS: The T2D risk was found to be low (M = 5.23, SD = 3.32) with more than two-third of the student population at the low risk level while a significant proportion of 23.8%, 5.6% and 0.3% having slightly elevated, moderate and high risk respectively. The T2D risk was significantly related to their age (rho = 0.197, p < 0.000), gender (U = 12641, p = 0.011), ethnic group (Χ2 = 18.86, p < 0.000), marital status (Χ2 = 6.597, p = 0.037), residence (U = 10345, p = 0.008), academic year (Χ2 = 14.24, p = 0.007) and physical activity (rho = -0.205, p < 0.000 and Χ2 = 13.515, p = 0.001). Of these, only age (β=0.130) and physical activity (β=-0.159) remained significant in the regression analysis.

    CONCLUSION: The findings call for a radical change in the nursing practice to target the amendable factors that are significant in order to prevent the progression of the risk towards type 2 diabetes.
    Matched MeSH terms: Risk Assessment
  6. Yii MK
    Asian J Surg, 2003 Jul;26(3):149-53.
    PMID: 12925289 DOI: 10.1016/S1015-9584(09)60374-2
    Abdominal aortic aneurysm (AAA) repairs represent a significant workload in vascular surgery in Asia. This study aimed to audit AAA surgery and evaluate the application of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) in an Asian vascular unit for standard of care. Eighty-five consecutive surgical patients with AAA from a prospective vascular database from July 1996 to December 2001 in Sarawak were available for analysis. Comparisons between predicted deaths by P-POSSUM and observed deaths in both urgency of surgery categories (elective, urgent, emergency ruptures) and risk range groups (0-5%, >5-15%, >15-50%, >50-100%) were made. No significant difference was found between the predicted and observed rates of death for elective, urgent and emergency AAA repairs. The observed mortality rates were 5%, 18% and 30%, respectively. The observed rates of death were also comparable to P-POSSUM predicted rates of death in the various risk range groups. The POSSUM score used with the P-POSSUM mortality equation is easy to use and applicable as a comparative vascular auditing tool in Asia.
    Matched MeSH terms: Risk Assessment
  7. Yang SR, Yeh YL
    Sains Malaysiana, 2015;44:1677-1683.
    Countering the dangers associated the present extreme climate not only requires continuous improvement of local disaster
    prevention engineering infrastructure but also needs an enhanced understanding of the causes of the disasters. This study
    investigates the geologic hazard risk of 53 slopeland villages in Pingtung county of southern Taiwan. First, remote sensing
    (RS) techniques were utilized to interpret environmental geology and geologic hazard zonation, including dip slope, fault,
    landslide and debris flow. GIS map overlay analysis was used to further identify the extent of the geologic hazard zonation.
    As a final step, field investigation is used to comprehend geologic, topographic conditions and the geologic hazard risk
    specific to each locality. Based on data analysis and field investigation results, this study successfully integrates RS, GIS
    and GPS techniques to construct a geologic hazard risk assessment method of slopeland village. The results of this study
    can be used to promote support for future disaster prevention and disaster mitigation efforts.
    Matched MeSH terms: Risk Assessment
  8. Ong SG, Cheng HM, Soon SC, Goh E, Chow SK, Yeap SS
    Clin Rheumatol, 2002 Sep;21(5):382-5.
    PMID: 12223986 DOI: 10.1007/s100670200102
    The aim of this study was to investigate the incidence of IgG anticardiolipin antibody (ACL) and IgG anti-beta(2) glycoprotein I antibody (anti-beta2GPI) positivity in patients with primary or secondary antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE), to assess the association between IgG ACL and anti-beta2GPI, and the relationship between the presence of ACL and anti-beta2GPI with the clinical manifestations of APS. IgG ACL and IgG anti-beta2GPI levels were measured in 51 SLE patients, 20 patients with SLE and APS (secondary APS) and 11 primary APS patients using commercially available ELISA kits. Relationships between laboratory data and clinical manifestations of the patients were examined. The incidence of IgG ACL positivity was significantly higher in primary (36.4%) and secondary (40%) APS than in SLE (13.7%) patients (P = 0.02). The incidence of IgG anti-beta2GPI positivity was significantly higher in primary (54.5%) and secondary (35%) APS than in SLE (7.8%) patients (P = 0.0006). Mean levels of IgG ACL and anti-beta2GPI were significantly higher in the primary and secondary APS than in the SLE patients (P = 0.002 for both). A significant relationship was found between IgG ACL and IgG anti-beta2GPI (P = 0.01, R(2) = 0.56). There was a significant correlation between the presence of IgG ACL and a history of thrombosis in the combined primary and secondary APS group, but not in SLE patients. In conclusion, in this study IgG ACL and IgG anti-beta2GPI are closely related and mean levels of IgG ACL and IgG anti-beta2GPI are higher in patients with either primary or secondary APS than in SLE patients.
    Study site: Rheumatology Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Risk Assessment
  9. Chow SK, Looi LM, Loh CS, Yeap SS
    Intern Med J, 2002 Mar;32(3):114-6.
    PMID: 11885838 DOI: 10.1046/j.1445-5994.2002.d01-29.x
    Matched MeSH terms: Risk Assessment
  10. Lau CS, Chia F, Dans L, Harrison A, Hsieh TY, Jain R, et al.
    Int J Rheum Dis, 2019 Mar;22(3):357-375.
    PMID: 30809944 DOI: 10.1111/1756-185X.13513
    AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice.

    MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique.

    RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery.

    CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.

    Matched MeSH terms: Risk Assessment
  11. Zheyuan C, Rahman MA, Tao H, Liu Y, Pengxuan D, Yaseen ZM
    Work, 2021;68(3):825-834.
    PMID: 33612525 DOI: 10.3233/WOR-203416
    BACKGROUND: The increasing use of robotics in the work of co-workers poses some new problems in terms of occupational safety and health. In the workplace, industrial robots are being used increasingly. During operations such as repairs, unmanageable, adjustment, and set-up, robots can cause serious and fatal injuries to workers. Collaborative robotics recently plays a rising role in the manufacturing filed, warehouses, mining agriculture, and much more in modern industrial environments. This development advances with many benefits, like higher efficiency, increased productivity, and new challenges like new hazards and risks from the elimination of human and robotic barriers.

    OBJECTIVES: In this paper, the Advanced Human-Robot Collaboration Model (AHRCM) approach is to enhance the risk assessment and to make the workplace involving security robots. The robots use perception cameras and generate scene diagrams for semantic depictions of their environment. Furthermore, Artificial Intelligence (AI) and Information and Communication Technology (ICT) have utilized to develop a highly protected security robot based risk management system in the workplace.

    RESULTS: The experimental results show that the proposed AHRCM method achieves high performance in human-robot mutual adaption and reduce the risk.

    CONCLUSION: Through an experiment in the field of human subjects, demonstrated that policies based on the proposed model improved the efficiency of the human-robot team significantly compared with policies assuming complete human-robot adaptation.

    Matched MeSH terms: Risk Assessment
  12. Tao H, Al-Hilali AA, Ahmed AM, Mussa ZH, Falah MW, Abed SA, et al.
    Chemosphere, 2023 Mar;317:137914.
    PMID: 36682637 DOI: 10.1016/j.chemosphere.2023.137914
    Heavy metals (HMs) are a vital elements for investigating the pollutant level of sediments and water bodies. The Murray-Darling river basin area located in Australia is experiencing severe damage to increased crop productivity, loss of soil fertility, and pollution levels within the vicinity of the river system. This basin is the most effective primary production area in Australia where agricultural productivity is increased the gross domastic product in the entire mainland. In this study, HMs contaminations are examined for eight study sites selected for the Murray-Darling river basin where the inverse Distance Weighting interpolation method is used to identify the distribution of HMs. To pursue this, four different pollution indices namely the Geo-accumulation index (Igeo), Contamination factor (CF), Pollution load index (PLI), single-factor pollution index (SPLI), and the heavy metal pollution index (HPI) are computed. Following this, the Pearson correlation matrix is used to identify the relationships among the two HM parameters. The results indicate that the conductivity and N (%) are relatively high in respect to using Igeo and PLI indexes for study sites 4, 6, and 7 with 2.93, 3.20, and 1.38, respectively. The average HPI is 216.9071 that also indicates higher level pollution in the Murray-Darling river basin and the highest HPI value is noted in sample site 1 (353.5817). The study also shows that the levels of Co, P, Conductivity, Al, and Mn are mostly affected by HMs and that these indices indicate the maximum HM pollution level in the Murray-Darling river basin. Finally, the results show that the high HM contamination level appears to influence human health and local environmental conditions.
    Matched MeSH terms: Risk Assessment
  13. Yap FBB
    Int J Dermatol, 2010 Feb;49(2):176-9.
    PMID: 20465642 DOI: 10.1111/j.1365-4632.2009.04342.x
    BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer among Orientals. Data on this malignancy is lacking in Malaysia, prompting a retrospective study to determine the clinical characteristics in the skin clinic, Sarawak General Hospital between 2000 and 2008.
    METHODS: Demographic data and clinical features of 64 histopathologically proven BCC from 43 patients were retrieved. Statistical analysis was performed comparing the clinical characteristics based on the region of involvement and gender.
    RESULTS: The mean age of presentation was 60.9 years. Male to female ratio was 1.05. Majority of the patients were Chinese (44.2%) followed by Malays (32.6%), Bidayuhs (14.0%) and Ibans (6.9%). Nodular BCC accounted for 95.3% of cases while 4.7% were superficial BCC. All the nodular BCC were pigmented. Ulceration was noted in 18%. There were 82.8% of BCC on the head and neck region and 17.2% on the trunk and limb region. BCC on the latter region were larger (mean 35.0 cf. 14.4 mm, p < 0.001) and ulcerated (45.5% cf. 11.3%, p = 0.01). Superficial BCC were also more frequently encountered in this region (18.2% cf. 1.9%, p = 0.02). Compared to women, men had larger BCC (mean 21.1 cf. 13.3 mm, p = 0.03) and kept them for a longer duration (mean 21.6 cf. 13.3 months, p = 0.04).
    CONCLUSION: Clinical characteristics of BCC in Sarawak were similar to other Asian studies. Additionally, BCC on the trunk and limbs and in men were larger, ulcerative and long standing warranting better efforts for earlier detection.
    Study site: Skin clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
    Matched MeSH terms: Risk Assessment
  14. Cheng WH, Yap CK
    Chemosphere, 2015 Sep;135:156-65.
    PMID: 25950409 DOI: 10.1016/j.chemosphere.2015.04.013
    Samples of mangrove snails Nerita lineata and surface sediments were collected from nine geographical sampling sites in Peninsular Malaysia to determine the concentrations of eight metals. For the soft tissues, the ranges of metal concentrations (μg g(-1) dry weight (dw)) were 3.49-9.02 for As, 0.69-6.25 for Cd, 6.33-25.82 for Cu, 0.71-6.53 for Cr, 221-1285 for Fe, 1.03-50.47 for Pb, and 102.7-130.7 for Zn while Hg as 4.00-64.0 μg kg(-1) dw(-1). For sediments, the ranges were 21.81-59.49 for As, 1.11-2.00 for Cd, 5.59-28.71 for Cu, 18.93-62.91 for Cr, 12973-48916 for Fe, 25.36-172.57 for Pb, and 29.35-130.34 for Zn while for Hg as 2.66-312 μg kg(-1) dw(-1). To determine the ecological risks on the surface habitat sediments, sediment quality guidelines (SQGs), the geochemical indices, and potential ecological risk index (PERI) were used. Based on the SQGs, all the metals investigated were most unlikely to cause any adverse effects. Based on geoaccumulation index and enrichment factor, the sediments were also not polluted by the studied metals. The PERI values based on As, Cd, Cu, Cr, Hg, Pb and Zn in this study were found as 'low ecological risk'. In order to assess the potential health risks, the estimated daily intakes (EDI) of snails were found to be all lower than the RfD guidelines for all metals, except for Pb in some sites investigated. Furthermore, the calculated target hazard quotients (THQ) were found to be less than 1. However, the calculated total target hazard quotients (TTHQ) from all sites were found to be more than 1 for high level consumers except KPPuteh. Therefore, moderate amount of intake is advisable to avoid human health risks to the consumers.
    Matched MeSH terms: Risk Assessment
  15. Al-Mutairi KA, Yap CK
    PMID: 33801910 DOI: 10.3390/ijerph18062798
    The heavy metal (HM) pollution in sediment is of serious concern, particularly in the Red Sea environment. This study aimed to review and compile data on the concentrations of four HMs (Cd, Cu, Pb, and Zn) in the coastal surface sediments from the Red Sea, mainly from Saudi Arabia, Egypt, and Yemen, published in the literature from 1992 to 2021. The coastal sediments included those from mangrove, estuaries, and intertidal ecosystems. It was found that the mean values of Cd, Cu, Pb, and Zn in coastal Red Sea sediments were elevated and localized in high human activity sites in comparison to the earth upper continental crust and to reference values for marine sediments. From the potential ecological risk index (PERI) aspect, 32 reports (47.1%) were categorized as 'considerable ecological risk' and 23 reports (33.8%) as 'very high ecological risk'. From the human health risk assessment (HHRA) aspect, the non-carcinogenic risk (NCR) values (HI values < 1.0) of Cd, Cu, Pb, and Zn represented no NCR for the ingestion and the dermal contact routes for sediments from the Red Sea countries. The reassessment of the HM data cited in the literature allowed integrative and accurate comparisons of the PERI and HHRA data, which would be useful in the management and sustainable development of the Red Sea area, besides being a helpful database for future use. This warrants extensive and continuous monitoring studies to understand the current and the projected HM pollution situation and to propose possible protective and conservative measures in the future for the resource-rich Red Sea ecosystem.
    Matched MeSH terms: Risk Assessment
  16. Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.
    J Gastroenterol Hepatol, 2018 Jan;33(1):20-29.
    PMID: 29023903 DOI: 10.1111/jgh.14019
    Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asian Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection, and prevention of latent TB infection and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised two parts: (i) risk of TB infection during anti-TNF therapy and (ii) screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
    Matched MeSH terms: Risk Assessment*
  17. Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.
    Intest Res, 2018 Jan;16(1):17-25.
    PMID: 29422794 DOI: 10.5217/ir.2018.16.1.17
    Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
    Matched MeSH terms: Risk Assessment
  18. Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.
    Intest Res, 2018 Jan;16(1):4-16.
    PMID: 29422793 DOI: 10.5217/ir.2018.16.1.4
    Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
    Matched MeSH terms: Risk Assessment
  19. Diana Yap FS, Ng ZY, Wong CY, Muhamad Saifuzzaman MK, Yang LB
    Med J Malaysia, 2019 02;74(1):45-50.
    PMID: 30846662
    INTRODUCTION: Increasing incidence of Venous Thromboembolism (VTE) has complicated treatment courses for hospitalised patients. Despite recommendation to support deep vein thrombosis (DVT) risk assessment and appropriate use of prophylaxis in medical inpatients, it is either neglected or prescribed unnecessarily by the clinicians. This study aimed to assess and compare the appropriateness of DVT prophylaxis prescribing between usual care versus a pharmacist-driven DVT Risk Alert Tool (DRAT) intervention among hospitalised medical patients.

    METHODS: A prospective pre- and post-intervention study was conducted among medical inpatients in a Malaysian secondary care hospital. DVT and bleeding risks were stratified using validated Padua Risk Assessment Model (RAM) and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Assessment Model. Pharmacist-driven DRAT was developed and implemented post-interventional phase. DVT prophylaxis use was determined and its appropriateness was compared between pre and post study using multivariate logistic regression with IBM SPSS software version 21.0.

    RESULTS: Overall, 286 patients (n=142 pre-intervention versus n=144 post-intervention) were conveniently recruited. The prevalence of DVT prophylaxis use was 10.8%. Appropriate thromboprophylaxis prescribing increased from 64.8% to 68.1% post-DRAT implementation. Of note, among high DVT risk patients, DRAT intervention was observed to be a significant predictor of appropriate thromboprophylaxis use (14.3% versus 31.3%; adjusted odds ratio=2.80; 95% CI 1.01 to 7.80; p<0.05).

    CONCLUSION: The appropriateness of DVT prophylaxis use was suboptimal but doubled after implementation of DRAT intervention. Thus, an integrated risk stratification checklist is an effective approach for the improvement of rational DVT prophylaxis use.

    Matched MeSH terms: Risk Assessment/methods*
  20. Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):87-95.
    PMID: 28888080 DOI: 10.1002/jhbp.504
    Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Risk Assessment
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