Displaying publications 41 - 60 of 359 in total

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  1. Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia
    Sethi D, Aljunid S, Saperi SB, Zwi AB, Hamid H, Mustafa AN, et al.
    J Trauma, 2002 Sep;53(3):508-16.
    PMID: 12352489
    The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia.
    Matched MeSH terms: Intensive Care Units/standards*; Intensive Care Units/utilization*
  2. Randomized controlled study of the effects of different durations of light exposure on weight gain by preterm infants in a neonatal intensive care unit
    Boo NY, Chee SC, Rohana J
    Acta Paediatr, 2002;91(6):674-9.
    PMID: 12162601
    A randomized controlled study was carried out on 96 preterm infants (< 37 wk) with birthweight less than 2000 g admitted to a neonatal intensive care unit. The aim was to compare the weight gain between preterm infants exposed to 12 h cyclical lighting (intensity of light: 78.4 +/- 24.7 lux, mean +/- SD) and those exposed to a continuously dim environment (5.9 +/- 1.9 lux). The exclusion criteria were infants with major congenital malformations or who needed continuous lighting for treatment procedure and care. From day 7 of life until discharge, 50 infants were randomized to receive 12 h cyclical lighting and 46 infants to a continuously dim environment. There was no significant difference in the mean birthweight (12 h lighting vs continuously dim: 1482 vs 1465 g, p = 0.8), mean gestational age (31.6 vs 31.4 wk, p = 0.6), median duration of hospital stay (28.5 vs 28.5 d, p = 0.8), mean age to regain birthweight (13.0 vs 12.9 d, p = 0.3), mean weight gained by day 14 (27.6 vs 36.2 g, p = 1.0), median weight gain per day (11.9 vs 12.2 g, p = 0.9) or median body weight on discharge (1800 vs 1800 g, p = 0.4) between the two groups of infants.

    CONCLUSION: Exposing preterm infants to either 12 h cyglical lighting or continuously dim environment did not have any significant effect on their weight gain during the neonatal period.

    Matched MeSH terms: Intensive Care Units, Neonatal
  3. Outcome of children with different accessibility to tertiary pediatric intensive care in a developing country--a prospective cohort study
    Goh AY, Abdel-Latif Mel-A, Lum LC, Abu-Bakar MN
    Intensive Care Med, 2003 Jan;29(1):97-102.
    PMID: 12528029 DOI: 10.1007/s00134-002-1534-9
    Objective: Lack of direct access to tertiary pediatric intensive care services in rural hospitals may be associated with poorer outcome among critically ill children. Inter-hospital transport by non-specialized teams may also lead to increased morbidity and even mortality. We therefore studied the outcome of children with different accessibility to tertiary pediatric care in Malaysia.

    Methods: We prospectively compared the Pediatric Risk of Mortality (PRISM II) adjusted standardized mortality ratio (SMR), unanticipated deaths and length of stay of 131 patients transported from rural hospitals (limited access) with 215 transferred from the casualty wards or other in-hospital wards (direct access) to a tertiary pediatric ICU.

    Results: The transported patients were younger than the in-hospital patients (median age 1.0 versus 6.0 months, p=0.000) and were more likely to have respiratory diseases. Other baseline characteristics did not differ significantly. Differences in access to tertiary intensive care from community hospitals was associated with an extended median length of stay (4.0 versus 2.0 days, p=0.000) but did not affect SMR (0.92 versus 0.84, rate ratio 1.09, 95% CI 0.57-2.01; p=0.348) or percentage of unexpected deaths (4.8% versus 2.8%, p=0.485). The adjusted odds ratio for mortality (1.7, 95% CI 0.7-4.3) associated with transfer was not statistically significant (p=0.248).

    Conclusions: The outcome of critically ill children transferred from community hospitals did not differ from that of those who develop ICU needs in the wards of a tertiary center, despite being transported by non-specialized teams. Outcome was not affected by initial inaccessibility to intensive care if the children finally received care in a tertiary center.
    Matched MeSH terms: Intensive Care Units, Pediatric*
  4. Nosocomial outbreak of Enterobacter gergoviae bacteraemia in a neonatal intensive care unit
    Ganeswire R, Thong KL, Puthucheary SD
    J Hosp Infect, 2003 Apr;53(4):292-6.
    PMID: 12660126
    A nosocomial outbreak of bacteraemia, caused by Enterobacter gergoviae infected 11 babies, nine of whom were premature, and was investigated in the neonatal intensive care unit (NICU) of a general hospital in Johor Bahru, Malaysia. The strain that was isolated from the babies was also isolated from the dextrose saline used for the dilution of parenteral antibiotics and from the hands of a healthcare worker on duty in the nursery. Pulsed-field gel electrophoresis (PFGE) of Xba I-digested chromosomal DNA confirmed a possible cross-contamination of parenteral dextrose saline and the healthcare worker. Prompt and effective control measures were initiated within NICU and the nosocomial infection of E. gergoviae was brought to an abrupt end. To the best of our knowledge, this is the first documented outbreak of E. gergoviae in the NICU in a hospital in the state of Johor, Malaysia.
    Matched MeSH terms: Intensive Care Units, Neonatal*
  5. Fulltext Audit on tracheostomies performed at the General Intensive Care Unit, Kuala Lumpur Hospital
    Rao AS, Mansor L, Inbasegaran K
    Med J Malaysia, 2003 Jun;58(2):213-7.
    PMID: 14569741 MyJurnal
    During a 6-month period from October 2000 to March 2001, we analysed the indications, methods, waiting period and complications following a tracheostomy at the General Intensive Care Unit (GIGU) of Hospital Kuala Lumpur. There were 49 tracheostomies performed during this period. Thirty of them were performed in the GICU using the percutaneous dilatational method while 19 were performed electively in the Operating Theatre (OT) by the ear, nose and throat (ENT) surgeons. The main indications for a tracheostomy were prolonged mechanical ventilation and airway protection for patients with a poor Glasgow Coma Scale. The average waiting time for a tracheostomy after a decision was made to perform one was 1.34 +/- 0.72 days for a percutaneous tracheostomy and 3.72 +/- 2.52 days for a surgical tracheostomy. This difference was statistically significant (p < 0.001). There was excessive bleeding in 3 patients in the percutaneous tracheostomy group and 1 patient in the surgical tracheostomy group. Percutaneous tracheostomy is now the main method of tracheostomy at the GICU in Hospital Kuala Lumpur. Haemorrhage is the most significant complication of this procedure. However the overall complication rate is comparable with that of a surgical tracheostomy.
    Matched MeSH terms: Intensive Care Units
  6. Impact of pharmacist recommendations on the cost of drug therapy in ICU patients at a Malaysian hospital
    Zaidi ST, Hassan Y, Postma MJ, Ng SH
    Pharm World Sci, 2003 Dec;25(6):299-302.
    PMID: 14689820
    To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions.
    Matched MeSH terms: Intensive Care Units/economics*
  7. Clinical course and determination of brainstem death in a children's hospital
    Goh AY, Mok Q
    Acta Paediatr, 2004 Jan;93(1):47-52.
    PMID: 14989439
    AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
    METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
    RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
    CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.

    Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom
    Matched MeSH terms: Intensive Care Units, Pediatric
  8. Fulltext A retrospective study of malaria infections in an intensive care unit of a general hospital in Malaysia
    Koh KH, Chew PH, Kiyu A
    Singapore Med J, 2004 Jan;45(1):28-36.
    PMID: 14976579
    To study the clinical and demographic aspects as well as the outcomes of severe cases of malaria infections managed in the intensive care unit of the Sarawak General Hospital, Kuching from January 1996 to December 2001.
    Matched MeSH terms: Intensive Care Units/statistics & numerical data*
  9. Antibiotic resistance patterns in nosocomial gram-negative bacterial infections in units with heavy antibiotic usage
    Ariffin H, Navaratnam P, Kee TK, Balan G
    J Trop Pediatr, 2004 Feb;50(1):26-31.
    PMID: 14984166
    The pattern of antibiotic resistance amongst gram-negative bacteria (GNB) in paediatric units, which have heavy empirical usage of broad-spectrum antibiotics, was studied prospectively over a 6-month period. A total of 200 consecutive, non-duplicate gram-negative isolates were obtained from 109 patients admitted to intensive care and oncology units in two hospitals. The commonest isolates were Klebsiella spp (36.5 per cent) and Pseudomonas (20.0 per cent). The isolates showed lower susceptibility rates to the third-generation cephalosporins (47-62 per cent) compared with cefepime (91 per cent), imipenem (90 per cent) and ciprofloxacin (99 per cent). Fifty-four (52.8 per cent) Klebsiella and Escherichia coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) producing strains. Antibiotics found to be effective against ESBL-producers were imipenem and ciprofloxacin. The high resistance rate amongst GNB to third-generation cephalosporins is a likely consequence of heavy empirical usage of this group of antibiotics. The carbapenems and quinolones remain useful agents in the management of patients admitted to these units.
    Matched MeSH terms: Intensive Care Units*
  10. Transport of critically ill children in a resource-limited setting: alternatives to a specialized retrieval team
    Goh AY, El-Amin Abdel-Latif M
    Intensive Care Med, 2004 Feb;30(2):339.
    PMID: 14727017 DOI: 10.1007/s00134-003-2112-5
    Matched MeSH terms: Intensive Care Units, Pediatric
  11. Smoothing a discrete hazard function for the number of patients colonized with Methicillin-resistant Staphylococcus Aureus in an intensive care unit
    Ismail NA, Pettitt AN
    Stat Med, 2004 Apr 30;23(8):1247-58.
    PMID: 15083481
    A new method for estimating the time to colonization of Methicillin-resistant Staphylococcus Aureus (MRSA) patients is developed in this paper. The time to colonization of MRSA is modelled using a Bayesian smoothing approach for the hazard function. There are two prior models discussed in this paper: the first difference prior and the second difference prior. The second difference prior model gives smoother estimates of the hazard functions and, when applied to data from an intensive care unit (ICU), clearly shows increasing hazard up to day 13, then a decreasing hazard. The results clearly demonstrate that the hazard is not constant and provide a useful quantification of the effect of length of stay on the risk of MRSA colonization which provides useful insight.
    Matched MeSH terms: Intensive Care Units/utilization
  12. Fulltext Using pulsed-field gel electrophoresis in the molecular investigation of an outbreak of Serratia marcescens infection in an intensive care unit
    Alfizah H, Nordiah AJ, Rozaidi WS
    Singapore Med J, 2004 May;45(5):214-8.
    PMID: 15143356
    Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in immunocompromised patients with severe underlying disease. An outbreak due to S. marcescens infection was detected from 13 to 22 February 2001 at the intensive care unit (ICU) of our institution. We used pulsed-field gel electrophoresis (PFGE) typing to analyse the outbreak strains involved.
    Matched MeSH terms: Intensive Care Units
  13. Fulltext Knowledge and skills of nurses in giving blood transfusion at Kota Bharu Hospital
    Yong, N.T., Tengku, M.A., Nurul, A.H., Mukkaramah, C.A., Ilunihayati, I.
    Malaysian Journal of Public Health Medicine, 2004;4(2):39-44.
    MyJurnal
    Risks of transfusion increase with the increase in the number and volume of transfusions occurring in hospitals year after year. Knowledge and practice of the nurses on proper transfusion techniques and risk reduction procedures should always be updated to ensure that transfusions are safely carried out. The study was done to determine the levels of knowledge and practice of trained nurses regarding blood transfusion in a general hospital. The study is a cross-sectional survey using a questionnaire, distributed to all staff nurses in the medical-based wards and intensive care unit (ICU) in the hospital. The total score were added for each category of knowledge and practice. Ninety one percent of the total population of staff nurses in medical based wards anti ICU were recruited into the study. A score of 80% or more in the knowledge and score of IOO% is required for practice to consider it as a pass, The outcome of the study showed that no one respondent in the study has achieved the required level, with regard to neither knowledge nor practice. The mean knowledge score was 54.8 with SD. of 9,9; while the mean practice score was 63 .8 with S.D. of 1.4. It was found that there was no rehtionship between knowledge score, nor practice score with the clinical postings (place of work) , work experience, and nursing qualification. This survey had indicated probkms faced by the nursing population in the hospital studied that there was a need to improve knowledge and practice levels with regards to blood transfusion procedure. It is crucial that updated information concerning transfusions be communicated to these nurses since they were the ones who carry out the procedures whilst continuously observing the patients during transfusion.
    Matched MeSH terms: Intensive Care Units
  14. Fulltext Turn-around-time of radiographs in a neonatal intensive care unit
    Rohana J, Boo NY, Yong SC, Ong LC
    Med J Malaysia, 2005 Aug;60(3):338-44.
    PMID: 16379189 MyJurnal
    A quality assurance study was carried out prospectively in two phases at the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Kebangsaan Malaysia. The objectives of the study were to determine the turn-around-time (TAT) of radiographs requested for infants undergoing intensive care treatment in the NICU and the effects of a standard operating procedure introduced based on initial findings of first phase of the study on subsequent TAT. The TAT was defined as the time taken for the radiograph to be ready for viewing after the attending doctor had requested for it to be done on an infant. During phase one of the study, none of the requested radiographs was ready to be viewed by the doctors within the standard TAT of 45 minutes. The problems identified were ward staffs delay in sending request forms to the radiology department, radiographers' delay in shooting and processing the films, and delay by NICU porter in collecting the processed films. Based on these findings, a standard operating procedure (SOP) was drawn up jointly by the staff of NICU and Department of Radiology. During phase two of the study conducted at one month after implementation of the SOP, there was a reduction of TAT by 50%. However, only 3 (4.3%) of the radiographs achieved the standard TAT. The main problems identified during phase two were delay in sending request forms and in collecting processed radiographs by the porter system. The dismal TAT of radiographs in NICU was related primarily to human behaviour. Besides continuous staff education, replacement of the porter system with electronic system may improve the TAT.
    Keywords: Turn-around time, radiographs, neonatal intensive care unit, standard operating procedure, Kuala Lumpur
    Matched MeSH terms: Intensive Care Units, Neonatal/organization & administration*
  15. International comparison of care for very low birth weight infants: parents' perceptions of counseling and decision-making
    Partridge JC, Martinez AM, Nishida H, Boo NY, Tan KW, Yeung CY, et al.
    Pediatrics, 2005 Aug;116(2):e263-71.
    PMID: 16061579
    To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.
    Matched MeSH terms: Intensive Care Units, Neonatal
  16. A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants
    Boo NY, Ng SF, Lim VK
    J Hosp Infect, 2005 Sep;61(1):68-74.
    PMID: 15953660
    To determine the risk factors for rectal colonization by extended-spectrum beta-lactamase (ESBL) Klebsiella sp. in 368 newborns admitted consecutively to a neonatal intensive care unit over six months, rectal swabs were cultured on admission and weekly until discharge. Eighty infants (21.7%) had ESBL Klebsiella sp. cultured from their rectal swabs. Eighty controls were selected at random from infants with negative cultures admitted within the 14-day period prior to the detection of ESBL Klebsiella sp. in the cases. Cases had significantly lower birth weight, gestational age, earlier age of admission, longer hospital stay, and higher proportions of congenital malformations, early-onset pneumonia and respiratory distress syndrome compared with controls. Significantly more cases received mechanical ventilation, nasal continuous positive airway pressure support, total parenteral nutrition, umbilical vascular catheterization, arterial line insertion, urinary bladder catheterization, and prior treatment with antibiotics. However, stepwise logistic regression analysis showed that only two independent risk factors were significantly associated with ESBL rectal colonization: duration of hospital stay [adjusted odds ratio (OR): 1.3; 95% confidence intervals (CI): 1.2, 1.4; P<0.0001) and early-onset pneumonia (adjusted OR: 8.3; 95% CI: 1.6, 43.4; P=0.01).
    Matched MeSH terms: Intensive Care Units, Neonatal
  17. An outbreak of Pantoea spp. in a neonatal intensive care unit secondary to contaminated parenteral nutrition
    Habsah H, Zeehaida M, Van Rostenberghe H, Noraida R, Wan Pauzi WI, Fatimah I, et al.
    J Hosp Infect, 2005 Nov;61(3):213-8.
    PMID: 16213372
    Contaminated parenteral nutrition (PN) is an important source of infection in neonates. Many organisms have been reported to cause contamination that results in outbreaks in intensive care units. The objective of this study was to investigate an outbreak caused by Pantoea spp., which contaminates PN, in a neonatal intensive care unit (NICU). This was a descriptive study of an outbreak of sepsis in an NICU of a tertiary teaching hospital in Malaysia. Pantoea spp. infection was detected in eight patients over a three-day period from 24 to 27 January 2004 following the administration of PN. Seven of the eight patients died due to the infection. Extensive environmental samplings for culture were performed. PN solution from the NICU and the pharmacy were also cultured during the outbreak period. Pantoea spp. was isolated from blood cultures of all infected patients, and the unused PN from the pharmacy and the NICU. All the strains of Pantoea spp. had a similar antibiotic susceptibility pattern and biochemical reaction. From the results, we concluded that PN was the source of the outbreak and the contamination may have occurred during its preparation in the pharmacy. A thorough investigation has been carried out and, where possible, corrective measures have been taken to avoid similar outbreaks in the future.
    Matched MeSH terms: Intensive Care Units, Neonatal*
  18. Cholestasis in very low birth weight infants who received parenteral nutrition
    Rohana, J., Latinah, M., Thambidorai, C.R., Kaur, B.
    Malaysian Journal of Paediatrics and Child Health, 2005;14(1):21-26.
    MyJurnal
    A retrospective study was conducted to evaluate the magnitude, clinical course and risk factors of cholestasis in surviving very low birth weight (VLBW) infants who received parenteral nutrition at the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia. Cholestasis was defined as direct hyperbilirubinaemia of >34 mmol/L. Between 1St July 2000 to 31St March 2001, 58 VLBW infants received parenteral nutrition (PN). Forty seven infants survived to discharge. Complete data was obtained from 43 (90.1%) infants. Thirteen (30.2%) of these infants developed cholestasis. The cholestasis persisted beyond the age of 6 weeks in 8 infants and they underwent hepato imino diacetic acid (HIDA) scan. The HIDA scan was reported as normal in 2 infants and inconclusive in 6 infants. Operative cholangiography. (OTC) was then performed in these infants and were all normal. The cholestasis finally resolved in all infants. Analysis of risk factors revealed that duration of assisted ventilation and PN and the presence of patent ductus arteriosus (PDA) had significant correlation with the development of cholestasis. These factors together with lower mean gestational age increased the likelihood of persistent cholestasis beyond 6 weeks of life in these infants. In conclusion cholestasis is common in VLBW infants who received parenteral nutrition. Although the clinical course seems benign, in a significant proportion of these infants it may persist longer and put them at increased risk of requiring invasive investigations.
    Matched MeSH terms: Intensive Care Units, Neonatal
  19. Fulltext Tetanus in adults--a continuing problem: an analysis of 217 patients over 3 years from Delhi, India, with special emphasis on predictors of mortality
    Anuradha S
    Med J Malaysia, 2006 Mar;61(1):7-14.
    PMID: 16708728
    Tetanus is still widely prevalent in many parts of the world especially in the developing countries. This study was conducted to assess the demographic and clinical features, treatment and outcome of tetanus in adults with a special emphasis on identification of predictors of mortality. This was a retrospective study of all adult patients admitted with tetanus over a three-year period from 1998 to 2000 at Lok Nayak Hospital, New Delhi, India. The demography, clinical features, treatment and complications of the patients were assessed and were evaluated against two possible outcomes- survival or death, to identify the predictors of mortality. There were 217 adults (148 males, 69 females) admitted with generalized tetanus during the study period. The mean age of the patients was 36.08 +/- 18.84 years. In most instances (63.5%), wounds / injuries served as the source of infection. Overall 31.8% had mild, 21.7% had moderate and 46.5% had severe disease at presentation. Respiratory failure and dysautonomia were the frequently observed complications. Of the 217 patients, 82 died - a mortality rate of 37.78%. Parameters that were significantly associated with increased mortality were: age (especially > 60 years); shorter duration of symptoms - trismus, rigidity and dysphagia; severe disease at presentation and shorter period of onset. Tetanus is a preventable disease associated with a high fatality rate. Universal coverage of immunization programme and appropriate wound prophylaxis is the corner stone of tetanus eradication. The treatment of tetanus is difficult and requires specialized and intensive care. The presence of parameters indicating an adverse outcome at the beginning in the patients will help identify the subset of patients that need more intensive management especially in resource poor nations.
    Matched MeSH terms: Intensive Care Units
  20. Fulltext The clinical picture of neonatal infection with Pantoea species
    Van Rostenberghe H, Noraida R, Wan Pauzi WI, Habsah H, Zeehaida M, Rosliza AR, et al.
    Jpn J Infect Dis, 2006 Apr;59(2):120-1.
    PMID: 16632913
    Pantoea infections are uncommon in humans. Most reports have involved adults or children after thorn injuries. There are only a few reports of systemic infections with Pantoea. This is the first report of the clinical picture of systemic Pantoea spp. infection in neonates as observed during an outbreak in a neonatal intensive care unit caused by infected parenteral nutrition solutions. Even though detected early, the infections had a fulminant course, causing septicemic shock and respiratory failure. Pulmonary disease was prominent and presented mainly as pulmonary hemorrhage and adult respiratory distress syndrome. The organism was sensitive to most antibiotics used in neonatal intensive care units, but the clinical response to antibiotic therapy was poor. The fatality rate was very high: 7 out of 8 infected infants succumbed to the infection (87.5%).
    Matched MeSH terms: Intensive Care Units, Neonatal
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