This study presents a systematic literature review of access control for electronic health record systems to protect patient's privacy. Articles from 2006 to 2016 were extracted from the ACM Digital Library, IEEE Xplore Digital Library, Science Direct, MEDLINE, and MetaPress using broad eligibility criteria, and chosen for inclusion based on analysis of ISO22600. Cryptographic standards and methods were left outside the scope of this review. Three broad classes of models are being actively investigated and developed: access control for electronic health records, access control for interoperability, and access control for risk analysis. Traditional role-based access control models are extended with spatial, temporal, probabilistic, dynamic, and semantic aspects to capture contextual information and provide granular access control. Maintenance of audit trails and facilities for overriding normal roles to allow full access in emergency cases are common features. Access privilege frameworks utilizing ontology-based knowledge representation for defining the rules have attracted considerable interest, due to the higher level of abstraction that makes it possible to model domain knowledge and validate access requests efficiently.
During a disaster, the rescuer must reach the disaster area within the fastest time with the help of navigation tools. However, there might be some obstacles during the night time that make the evacuation of the victims difficult especially due to the bad weather. Hence, an attempt to produce glow-in-the-dark emergency signage to ease the evacuation process and to enhance visibility during night time is necessary. In this present study, particular emphasis is given to investigate the characteristic of photo-luminescent (PL)powder applied with polyester resin as glow-in-the-dark emergency signage. Five samples of signage were fabricated with different percentage of PL powder, i.e. 20%, 40%. 60%, 80% and 100% and mixed with 150g polyester resin. Three types of luminance test were performed to check the workability of the samples. The tests are physical appearance, one-hours illuminance test and afterglow duration tests. The result showed that the maximum lux meter reading was recorded in Sample 5 with 6 lux luminosity and provided the longest glow duration of the sample before completely off after 12-hours. Results proved that the highest percentage of the PL powder content, the longer the afterglow duration will be achieved. It also noted that the polyester resin could be a good binder of PL powder for producing the glow-in-the-dark emergency signage.
Evacuation profile systems in high rise building are important to determine the safety level during any fire
emergency. In relation to this, the study was conducted with its objective to develop the evacuation profile for
NIOSH Tower. Evacnet-4 software was used to develop models for building evacuations using the building network
descriptions and the initial content of the occupant at the beginning of the evacuation. The results show that it
requires 390 seconds to evacuate NIOSH tower, with the highest number of bottlenecks recorded for the Third Floor.
Identification of bottleneck is important to determine the evacuation periods. The information gained from the model
may be used for the emergency response planning and for support material. The model should be tested in real time
to have its reliability verified.
The importance of rapid ambulance response to emergency medical crises is undeniable. An early
access to advanced care is crucial to saving a life. Modern computerised call centre and the hospitalbased ambulance services are believed to enhance the quality of service delivery. However, whether
it will further reduce the ambulance response time is still debatable. A cross-sectional study was
conducted in June 2012 until July 2012 at three selected tertiary hospitals in Malaysia. The
ambulance response time was expressed in a median and interquartile range (IQR) and MannWhitney U test was used to determine the associations between types of ambulance and
computerised call centre system versus voice only. Wilcoxon Rank Sign Test was used to assess
the significance of means difference. A hospital-based ambulance had the median time of 0.19
minutes while community-based ambulance had the median time of 0.20 minutes (The Z score -
0.916, p-value - 0.360). The hospital with computer call centre had the median time of 0.19 minutes
while hospital without computer call centre had the median of 0.20 minutes (The Z score - 0.816, P
value - 0.414).The response time of hospital-based ambulance equipped with computerised call
centre system was comparable in three selected tertiary hospitals in Malaysia.
Emergency left-sided colonic resections have traditionally been dealt with by employing staged resections due to the dangers of an anastomosis in unprepared bowel. A small series of 6 patients with left-sided colonic obstruction is presented in which a single stage primary anastomosis was done after an antegrade intraoperative colonic lavage. There were no deaths, infective complications or anastomotic leaks. Major series in the last decade using intraoperative colonic lavage are reviewed as well, to confirm that the method is safe, effective and warrants wider usage locally.
We reviewed the deliveries in a teaching hospital in a multiracial community over the period of one year (1988), and investigated the relationship between maternal height, ethnic origin, and the extremes of birth weight with the likelihood of emergency lower segment caesarean section (LSCS). After excluding patients with obvious indications for LSCS, 5,050 patients were entered in the study. Chi-square analysis showed that the risk of emergency LSCS is significantly higher in the Indians compared to Chinese and Malays, but does not differ significantly between the latter two groups. Logistic regression analysis showed that birth weight of less than 2,500 g or greater than 3,500 g is the most significant association with emergency LSCS rate. Conditional logistic regression showed that, provided the individuals conformed to the characteristics of the cohort in this study, risk of emergency LSCS for a 150 cm (25th centile) tall Indian pregnant lady is almost twice that of a 158 cm (75th centile) tall non-Indian).
We collected data on patients above the age of 5 years with acute bronchial asthma who presented to the emergency room of Hospital Sains Universiti Sains Malaysia during the period between 1 January to 31 March 1990. Two hundred and twelve patients (57% males and 43% females) who made a total of 271 visits were recorded. This constitutes 16.3% of all adults and paediatric medical cases seen in the emergency room during this period. The majority of patients presented between 8 pm and 6 am which contrasts with the attendance pattern due to other causes. We also recorded two peak periods of presentation (between 8 pm and 12 midnight and between 6 am and 10 am). Thirty-one (11.4%) cases resulted in admission. Of the 240 cases that were successfully treated and discharged from the emergency room, there were 59 relapses (in 45 patients). Twenty-two percent of the relapses occurred within 24 hours of the last visits. We recorded lower rates of admission as well as relapses compared to all previous studies. Our finding of bimodal pattern of presentations was also not previously reported.
Study site: Emergency department, Hospital Sains Universiti Sains Malaysia, Kelantan, Malaysia
The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates
Accidental injuries are one of the leading causes of morbidity and mortality
worldwide. Approximately 1.25 million lives are cut short because of road traffic
accident every year. As the incidences of emergencies is steadily increasing in recent
years, it is important to ensure that individuals are adequately trained to deal with such
events including university students. First aid is given to preserve life and minimize the
consequences of injury and illness until help is obtained from health care practitioners.
This study aimed to assess the level of knowledge, awareness and attitude related to
first aid among IIUM Kuantan campus students. (Copied from article).
The paramedic team of Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia (USM) is often involved in providing medical assistance for various activities organised by the university such as during PIMPIN siswa outdoor training and sport events. Paramedics often faced difficulty in saving injured patients as the current stretcher is rather heavy (5.8 kg) and is not able to be folded to a smaller size. To overcome this problem, i-TAG, a stretcher made of durable two-layer canvas cloth with the size of 170.0 cm x 74.0 cm and equipped with 10 user-friendly rubber handle, has been invented. The upper part of the stretcher has a zip to insert the spinal board if the victim has spinal and head injuries. The i-TAG is also very light with only 1.2 kg in weight, easy to be folded and stored in emergency bags, and can be easily carried by paramedics. The i-TAG innovative product has a positive impact on health and safety services. Using i-TAG, the task to carry patients or injured victims becomes easier, faster, saves energy and subsequently increases the efficacy of the rescue and medical aid tasks by paramedics.
Massive haemoptysis is the most dreaded of all respiratory emergencies. Bronchial artery embolisation is known to be a safe and effective procedure in massive haemoptysis. Bronchial artery of anomalous origin presents a diagnostic challenge to interventional radiologists searching for the source of haemorrhage. Here, we report a case of massive haemoptysis secondary to a lung carcinoma with the bronchial artery originating directly from the right subclavian artery. This artery was not evident during the initial flush thoracic aortogram. The anomalous-origin bronchial artery was then embolised using 15% diluted glue with good results. An anomalous-origin bronchial artery should be suspected if the source of haemorrhage is not visualised in the normally expected bronchial artery location.
Malaysia is blessed with oil and gas resources, which form raw materials for the petrochemical industry. The petrochemical industry creates added value to this resource and is an important contributor to the national economy. The petrochemical industry however also creates hazards of which fire or explosions and chemical release are of special concern. These hazards pose a risk not only to workers but also to the surrounding population and environment. To ensure industry is prepared to cope with emergencies, a comprehensive emergency response programme is necessary. This is inline with both the Malaysian Occupational Safety and Health (Control of Industrial Major Accident Hazards) Regulations 1996 and the Responsible Care initiative of the chemical industry. This paper describes elements to be considered in an emergency response programme for industry such as the concept of emergency management, organisation, duties and responsibilities, emergency system, training and mutual aid plans and agreements. We shall provide related examples based on a multinational petrochemical company practice.
A report of a patient with Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation) following cardiac arrest (myocardium ischemia) is presented. A 65 year patient was found unconscious at home. He taken to the emergency department On arrival he was unconscious, his pupils fixed and dilated bilaterally. Resuscitation proceeded for 55 minutes. He was then pronounced dead. Forty minutes later spontaneous breathing was noted and his blood pressure was 110/48 and heart rate 90bpm. He survived a further 13 days in the coronary care unit. The implications for management of cardiac arrest in the emergency and medical department are discussed.
Fire emergencies are threat to the occupants of a residential college. Some of the Malaysian residential colleges were built in the 1970s. Back then, the compliancy to Uniform Building By-law 1984 was not entirely practiced. This study aims to evaluate fire safety measures in selected residential colleges of a Malaysian University, which were built before 1984. This includes occupants’ level of awareness and knowledge of the occupants regarding fire safety measures. This study was conducted in selected residential colleges, built before 1984, which were named as A, B, C, and D Colleges. One new college building was selected to be the control variable, the E College. Survey questionnaires were given to 401 respondents to obtain information regarding the fire safety awareness and knowledge. Fire safety inspections were conducted to determine the level of fire safety protection systems in colleges and the documentation of emergency response plan were reviewed. From the study, the level of fire safety awareness among the occupants were higher compared to their fire safety knowledge. Fire safety inspection result indicated that overall buildings inspected complies with the local regulation while safety documentation reviews were satisfactorily adequate. Overall, the score for fire safety measures in all selected colleges were sufficient and in good condition. This study is significant for those in the field of safety and health practice pertaining to fire safety engineering and regulations, to plan for better and more efficient fire hazard and risk assessment.
A retrospective cohort study of 206 consecutive patients with colorectal cancer presenting to three general surgeons in the University Hospital, Kuala Lumpur over a 3-year period is reported. In all, 184 patients had an operation and are grouped according to whether their operation was within 24 hours of admission (n=16), more than 24 hours after admission (n=38), or elective (n=130). Operative mortalities for these groups were 15.9%,15.2°/o and 6.5%, respectively, significantly higher in both the emergency groups. Delayed surgery to allow complete resuscitation did not improve the operative mortality when compared with those patients having urgent surgery. Both groups of emergency patients, delayed (27%) and urgent (19%), showed poorer 5-year survival than the electively treated patients (36%), many dying of non-cancer causes. Patients who undergo emergency surgery for colorectal carcinoma are more l i k e l y to be in poorer physical condition than the patients undergoing elective surgery for the same condition. It appears that the physical status is the principal determinant of outcome after emergency colorectal surgery rather than any other factor. KEYWORDS: colorectal cancer, emergency, outcome