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Fulltext Nurses’ perceptions and attitudes towards family presence during resuscitation in adult critical care units

Chung Su Chin, Pauline Stitt

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):61-0.
MyJurnal

Introduction: During resuscitation efforts, patients’ families are routinely barred from the resuscitation area. Even there is an increased in demand from the family members requesting to be present during resuscitation of their loved one, health care providers not always offer the option for family presence. The major concerns of health care providers who are opposed to family presence during resuscitation (FPDR) were fear of psychological trauma to family members who witnessed the resuscitation. This study aimed to examine the critical care nurses’ perception and attitudes towards the presence of patients’ family members during resuscitation in adult critical care units. Methods: Study papers included were narrowed to primary study, published within 2003-2014, describing nurses’ perceptions and attitudes on an adult inpatient family witnessed resuscitation in critical care units. Results: Seven studies included, and four main themes emerged mainly samples population, nurses’ experiences of FPDR, nurses’ responses toward FPDR and factor predicting nurses’ attitudes toward FPDR. 20% - 42.2% of nurses had experienced FPDR. Only 4% - 6% of study participants working in hospital with established policy and 95% - 100% had not invited family members to witnessed resuscitation. Nurses would consider the option if family members are accompanied by trained staff. Nurses concern included difficult to concentrate, negatively affecting their per- formance, increased rate of legal action, inadequate staff and limited space. Concerns on family members included too distressing event, negative psychological impact argue and interfere with staff. Concerns on patient would be breach of confidentiality. Conclusion: Adult critical care nurses demonstrated negative perceptions and attitudes towards FPDR. Study participants in this review are not familiar with the concept of FPDR. There is a need for policy development and education on FPDR.

Matched MeSH terms: Inpatients
Fulltext Antimicrobial stewardship program in a Malaysian district hospital: First year experience

Sing DY, Boo YL, Mukhlis R, Chin PW, Hoo FK

Pak J Med Sci, 2016 Jul-Aug;32(4):999-1004.
PMID: 27648056

Backgrounds & Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital.
Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above.
Results: Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004).
Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.
KEY WORDS: Antimicrobial stewardship, Anti-Infective agents, Drug resistance, Malaysia, Rural hospital

Matched MeSH terms: Inpatients
Fulltext Factors influencing inpatient duration among insanity acquittees in a Malaysian mental institution

Chan, Lai Fong, Tuti Iryani Mohd Daud, Hazli Zakaria, Phang, Cheng Kar, Loo, Tsui Huei, Ong, Lieh Yan, et al.

ASEAN Journal of Psychiatry, 2010;11(1):25-35.
MyJurnal

Objective: According to Malaysian law, defendants found not guilty by reason of insanity may be admitted to a psychiatric hospital and discharge is subject to the state ruler’s assent. The objective of this study is to examine the clinical, socio-demographic and forensic factors that influence inpatient duration of insanity acquittees in a Malaysian mental institution. Methods:This is a cross-sectional study of one hundred and twelve insanity acquittee inpatients in Hospital Bahagia Ulu Kinta from January 2007 to February 2007. Patients with a clinical diagnosis of schizophrenia, major depressive disorder and bipolar disorder were assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD) and Young Mania Rating Scale (YMRS) respectively. Other relevant sociodemographic, clinical and forensic factors were also assessed. Results: The inpatient duration varied widely from three months to forty-seven years with a median of seven years. Seventy five percent of patients were in remission. According to the multiple linear regression model, the strongest predictor of a longer duration of hospital stay for insanity acquittees was older age (p

Matched MeSH terms: Inpatients
Fulltext Traditional healers are causing treatment delay among patients with psychosis in Hospital Kuala Lumpur: fact or fallacy?

Marhani Midin, Salina Abdul Aziz, Phang, Cheng-Kar

ASEAN Journal of Psychiatry, 2010;11(2):206-215.
MyJurnal

Objective: Mental health services in Malaysia often face competition from traditional healers especially among patients with psychosis. The objective of the study is to determine whether patients who sought help earlier from traditional healers had longer duration of untreated psychosis (DUP), and more adverse experiences in pathways to psychiatric care. Methods: This is a hospital-based cross-sectional study of 50 inpatients with first-episode
psychosis in Hospital Kuala Lumpur. Structured Clinical Interview for DSM-IV (Diagnostic and statistical manual, 4th edition) Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Onset of psychosis was defined as any one positive symptom with a score of >3 on the Positive and Negative Syndrome Scale (PANSS). Socio-demographic
data, information on pathways and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaire. Results: Fifty-four percent of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact
(48%). Contact with traditional healers was not associated with age, gender, ethnic, education level, longer DUP or treatment delay, and admissions with violent behaviour or police assistance. Of those who had sought help from traditional healers, one third were recommended by at least one of their traditional healers to seek medical help. Conclusion:
Consultation involving traditional healers was a popular choice, and not associated with treatment delay. Traditional healers in an urban setting may be potential collaborators in managing patients with first-episode psychosis. Future research should explore the frontiers of such collaborative work.

Matched MeSH terms: Inpatients
Fulltext Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists' perceptions

Chan HK, Hassali MA, Lim CJ, Saleem F, Ghani NA

Pharm Pract (Granada), 2016 Apr-Jun;14(2):699.
PMID: 27382422 DOI: 10.18549/PharmPract.2016.02.699

BACKGROUND: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used.
OBJECTIVE: To identify potential areas to improve the existing labels used for pediatric liquid medications.
METHODS: This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach.
RESULTS: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions.
CONCLUSION: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.
KEYWORDS: Child; Drug labeling; Hospital; Hospital Information Systems; Malaysia; Medication Errors; Pharmacy Service

Matched MeSH terms: Inpatients
Fulltext A descriptive cross sectional study on patient satisfaction in a private hospital in Selangor

Narimah, A.H.H., Shahril Rizwan, O., N Nadhrah, N.R., Adlina, S., Hakimi, Z.A., Nuraliza, A.S.

Malaysian Journal of Public Health Medicine, 2006;6(2):6-12.
MyJurnal

This descriptive cross sectional study was conducted to assess patient's satisfaction by evaluating the waiting time experienced by 27 (54%) inpatients and 23 (46%) outpatients who sought treatment at a private hospital in Selangor from 15th of May 2006 until 3rd of]une 2006. Majority of the patients (78%) were in the range between Z 1 - 40 years old and well»educated. Almost half (48%) were in the human resources employment category, 20% were in administration and marketing and 10% were professionals. Majority of them earned from RM1000-1999 (34%) and RMZ000-3999 (32%). Almost all of them (96%) agreed that the medical care that they had been receiving in the hospital was just about perfect. 98% agreed that the doctors treated them in a very friendly and courteous manner and 96% rated the care given by nurses as g0od/ excellent. 88% to 92% said that their communication with the doctors, nurses and other staff were good/ excellent. 80% waited less than 15 minutes at the registration counter, 52% waited less than 15 minutes to see the doctor and 44% waited less than 15 minutes at other places such as pharmacy and x-ray. Overall, 94% rated the level of services in the hospital as good/ excellent, Almost all (90%) would like to recommend the hospital to their friends and relatives. Our study demonstrated that the majority of the patients were satisfied with the doctors, nurses and environment of the private hospital. The average waiting time of patient before being attended to by a doctor was less than 30 minutes.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Inpatients
Fulltext Prevalence & Experience Of Contact With Traditional Healers Among Patients With First-Episode Psychosis In Hospital Kuala Lumpur

Phang, C.K., Marhani, M., Salina, A.A.

Malaysian Journal of Psychiatry, 2010;19(2):1-9.
MyJurnal

Introduction: Patients with mental disorders in Malaysia often seek help from traditional healers prior to consulting psychiatric service. The objective of the study is to determine the prevalence and experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and experience of contact with traditional healers were determined through face-to-face interview and semi-structured questionnaires. Results: Twenty seven (54%) of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). About a quarter of them (24%) had 3 or more contacts with traditional healers prior to consulting psychiatric service. The most common type of traditional treatment received was prayer (25, 96.3%). Only 2 patients (7.41%) reported having some beneficial effects from traditional treatments. There were two patients who reported having adverse experience with traditional healers. Among those who had sought help from traditional healers, one third was recommended by at least one of their traditional healers to seek medical help. Conclusion: History of contact with traditional healers prior to consulting psychiatric service was common among inpatients with first-episode psychosis in HKL. There may be potential meaningful collaborations between psychiatrists and traditional healers for better management of patients.

Matched MeSH terms: Inpatients
Fulltext Economic impact of managing acute diabetic foot infection in a tertiary hospital in Malaysia

Lam AWC, Zaim MR, Helmy HH, Ramdhan IMA

Malays Orthop J, 2014;8(1):46-49.
MyJurnal

Diabetic foot disease is the leading cause of non-traumatic amputations of the lower limb, hence a major health care and socioeconomic burden. It has been found that most of the costs occur in the inpatient setting; therefore this study is to quantify the costs of managing inpatient diabetic foot infections (DFI). We treated 182 inpatients from May 2012 till April 2013 and analysed the cost of antibiotic usage, wound dressing, surgical procedure, admission and basic investigation costs. The total cost was ~ USD 11,000 (2013). This number, however, only reflects the cost for managing an acute infection. The price for follow-up care as an outpatient, rehabilitation and indirect costs (emotional suffering, reduced productivity) is estimated to be much more.
Study site: Diabetic Inpatient Registry, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia

Matched MeSH terms: Inpatients
Fulltext An evaluation of health centers and hospital efficiency in Kampala capital city authority Uganda; using Pabon Lasso technique

Nabukeera, M., Boerhannoeddin, A., Raja Noriza, R.A.

JUMMEC, 2015;18(1):1-6.
MyJurnal

The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.

Matched MeSH terms: Inpatients
Fulltext Validation of the Malay version of auditory verbal learning test (MVAVLT) among schizophrenia patients in Hospital Universiti Sains Malaysia (HUSM), Malaysia

Zahiruddin Othman, Muhammad Najib Muhammad Alwi, Kamarul Imran Musa, Muhammad Najib Muhammad Alwi, Ruzita Jamaluddin

ASEAN Journal of Psychiatry, 2009;10(1):54-74.
MyJurnal

Objective: Many studies have emphasized the significance of verbal memory for the functional outcome in schizophrenia. A preserved capability to encode and recall verbal information is essential for the long-term efficacy of psychoeducational programs and other
psychological intervention to ensure the successful transfer of newly acquired skills or knowledge into everyday life. Aims of this study aimed to validate the MVALT among schizophrenia patients in HUSM. Methods: The subjects were 15 schizophrenia patients
conveniently selected from the patients that attended follow up at the psychiatry clinic in HUSM or inpatients who have been admitted during the study period and 15 healthy control subjects as a comparison. Reliability and validity of the MVAVLT were analyzed. Results: The validation study showed that the Malay version Auditory Verbal Learning Test (MVAVLT) had a good validity (factor analysis 0.66 to 0.98) and test-retest reliability (pearson correlation ranged from 0.24 to 0.84) and has been shown to be sensitive in
discriminating between normal and schizophrenia patients. In line with the previous research, the schizophrenia patients performed significantly worse than healthy control in all indexes measured in MVAVLT. Conclusion: The screening of deficits in verbal learning
and memory among the schizophrenia patients is important, for early detection and treatment since it can be helpful for clinicians and psychologists in their counseling sessions. Subsequently, it helps patients to reduce such cognitive difficulties and their impact by using specific rehabilitation with the usage of newer antipsychotic agents.

Matched MeSH terms: Inpatients
Fulltext Depression and functional level in schizophrenia: a comparison between chronic hospitalised in-patients and community care patients

Tan, John J.T., Nor Zuraida, Z., Mohamad Omer, H., Gill, Jesjeet Singh, Lau, Kelvin H.K.

JUMMEC, 2007;10(2):31-36.
MyJurnal

Recent innovations in the treatment of schizophrenia reflect a growing trend towards community-based care. Malaysia had in the past few years attempted to deinstitutionalise mental patients in the mental hospitals. Therefore it is important to conduct research to compare the two groups of schizophrenia patients (community-based patients against chronic hospitalised patients) to ascertain if deinstitutionalisation has been beneficial. The main objective of the study was to compare levels of depression and function in community-based patients against chronic hospitalised patients as depression is prevalent among schizophrenia patients. This study was cross sectional in nature where data was collected from 51 inpatients in Hospital Bahagia Ulu Kinta (HBUK) and 23 community-based patients. Calgary Depression Scale for Schizophrenia (CDSS) and Global Assessment of Functioning scale (GAF) were the assessment tools used. Community-based patients were found to have significantly lower scores in the CDSS scale (1.96) as compared to chronic hospitalised patients (4.04); p < 0.01). They also showed higher functional capability between community-based and hospitalised patients respectively (74.04 vs 57.92) respectively. (p < 0.001). Community services appeared to be more effective than long stay in-patient services in preventing depression and promoting better functional levels.

Matched MeSH terms: Inpatients
Fulltext Care demands-related concerns and perceived service needs of families of people with mental illness in the community

Saloma, P., Chan, K.G., Ong, M.F.

Malaysian Journal of Psychiatry, 2014;23(1):17-26.
MyJurnal

Owing to reduced inpatient stays, people with mental illness (PMI) were often discharged from the hospital in ‘acute’ conditions. During this transition period of fragility, the relocation of care from hospital to home has tremendous impact on every aspect of a family’s life as they need to face a challenging task of caring especially when they are ‘not ready’ and ‘ignorant’ about the chronicity and severity of the illness. Furthermore, where economic and psychological support is concerned, those who are undertaking this task may require significant professional guidance. Aims: This study examines the experiences of 100 families in caring for people with mental illness in the community. Methods: Qualitative interviews were conducted in their homes within three Malaysian states of Sabah, Sarawak and Johor in year 2013. Results: Three themes emerged from the findings of ‘care demands related concerns’ of these families. These include theme (1): care provision related concerns of families which were related to the needs of people with mental illness for continuing care provision, their non-compliance with medication and relapse, altered sleep pattern, limited self-care ability, behavioral problems and also social isolation. Theme (2): perceived availability of resources of service provision/support which were related to activities planned for the families before the discharge of the people with mental illness and theme (3): family members perceived service needs whereby they informed of their needs such as continual health care through home visit, provision of financial aid, job coach service, centre for care provision of PMI and rehabilitative programs.

Matched MeSH terms: Inpatients
Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study

Zamli AH, Ratnalingam K, Yusmido YA, Ong KG

Spinal Cord Ser Cases, 2017;3:16044.
PMID: 28503317 DOI: 10.1038/scsandc.2016.44

INTRODUCTION: This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury.
MATERIALS AND METHODS: The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded.
RESULTS: SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings.
DISCUSSION: The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.

Study site: Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia

Matched MeSH terms: Inpatients
Fulltext Early readmissions and associated socio-demographic, clinical factors in a psychiatric hospital, Malaysia

Lee, Wen Jih, Ong, Lieh Yan, Koay, Siew Ni, Kwan, Zuan Er

ASEAN Journal of Psychiatry, 2017;18(1):0-0.
MyJurnal

Objective: The main aim of this study is to assess the prevalence of early
readmissions to inpatient care in Hospital Bahagia Ulu Kinta and the associated
socio-demographic and clinical factors.

Methods: This is an observational study
for all patients with readmissions within 3 months from the last discharge, dated
from 1 January 2013 to 31 December 2013. Related socio-demographic and
clinical details are obtained from the medical records and compared between the
patients who were readmitted within the first month after discharge to those who
were readmitted later in the second and third month.

Results: Total of 149
records of patients who were readmitted within 3 months of last discharge were
analyzed. Majority of them were from the same state of Perak (83.9%), male
(74.5%), single (71.1%), unemployed (85.9%), taken care by family (75.2%),
achieved secondary education level (59.7%) with mean age of 37.89 years (SD
11.53). They were discharged for a mean of 32.52 days (SD 26.48) before
readmission with a mean duration of 72.98 days in the previous admission, and
mean previous admissions of 10.17 times. 69.8% of the patients were treated for
psychotic disorders and the main reason for readmission was relapse (84.6%).
Up to 34.2% of the patients reported to have substance abuse while 25.5% had
medical co-morbidities. Most of the patients (63.8%) were not compliant to the
treatment from the last discharge. Socioeconomic and clinical factors did not
show statistical significance when the readmissions within the first month after
discharge were compared to those who were admitted later at the second and
third month.

Conclusions: Due to limitations, further studies need to be done to
identify risk factors associated with readmissions and adequate measures need to
be taken to prevent these readmissions.

Matched MeSH terms: Inpatients
Fulltext Morbidity patterns and healthcare utilisation among older people in Malaysia: 1996-2015

NoorAni A, Rajini S, Balkish MN, Noraida MK, SMaria A, Fadhli MY, et al.

Public Health, 2018 Aug 16;163:105-112.
PMID: 30121437 DOI: 10.1016/j.puhe.2018.06.018

OBJECTIVE: This article examines the trends in morbidities and healthcare utilisation in Malaysian older people aged 60 years and above.
STUDY DESIGN: This is a repeated cross-sectional study.
METHODS: Data from three nation-wide community-based surveys, which were conducted in 1996, 2006, and 2015 were analysed. Multivariate analysis was performed for 2015 data to identify factors associated with healthcare utilisation.
RESULTS: Analysis noted increasing trends in the prevalence of diabetes, hypertension, hypercholesterolaemia and obesity from 1996 to 2015. Decreasing trends were noted in the prevalence of current smokers and drinkers over this 20-year period, whereas health service utilisation increased with age in all surveys. In 2015, both inpatient and outpatient care are significantly associated with increasing age and diabetes.
CONCLUSIONS: Increasing trends of health problems and healthcare utilisation were observed among older people in Malaysia. Policymakers should plan for appropriate resources to meet the challenges of an ageing population in Malaysia.
Study name: National Health and Morbidity Survey (NHMS-1996, NHMS-2006, NHMS-2015)

Matched MeSH terms: Inpatients
Psychometric properties of the Malay version of motivation scales in drug treatment

Shukri M, Min RM, Abdullah SS, Yusof RAM, Husain Z

Med J Malaysia, 2019 Oct;74(5):377-384.
PMID: 31649212

INTRODUCTION: In recognition of the role of motivation in drug use treatment, patient motivational screening instruments are needed for strategic planning and treatment. The aims of this study were to evaluate the reliability and validity of the Malay version of the Treatment Motivation Scale, and to compare the motivational levels of patients receiving substance abuse treatment with different modalities (inpatient vs. outpatient). The motivational scale consists of three scales: problem recognition, desire for help and treatment readiness.
METHOD: A convenience sample of 102 patients was recruited from four Cure and Care Service Centres in Malaysia.
RESULTS: Principal component analysis with varimax rotation supported two-factor solutions for each subscale: problem recognition, desire for help and treatment readiness, which accounted for 63.5%, 62.7% and 49.1% of the variances, respectively. The Cronbach's alpha coefficients were acceptable for the overall measures (24 items: ∝ = 0.89), the problem recognition scale (10 items; ∝ = 0.89), desire for help (6 items; ∝ = 0.64) and treatment readiness scale (8 items; ∝ = 0.60). The results also indicated significant motivational differences for different modalities, with inpatients having significantly higher motivational scores in each scale compared to outpatients.
CONCLUSION: The present study pointed towards the favourable psychometric properties of a motivation for treatment scale, which can be a useful instrument for clinical applications of drug use changes and treatment.

Matched MeSH terms: Inpatients
Fulltext History of falls and its relationship with nutritional status among elderly patients. [Sejarah jatuh dan hubungannya dengan status pemakanan di kalangan pesakit warga tua]

Cheng SH, Shahar S, Lee FS, Ramli A

Sains Malaysiana, 2012;41:379-385.

Rising risk of falls has been associated with injury and dysfunction among the elderly. Therefore, this study was conducted to determine the prevalence of falls and association with nutritional status among 143 elderly patients from medical ward and clinic in Hospital Kuala Lumpur. Anthropometric indicators and bone health status using quantitative ultrasound (QUS) were also assessed. History of falls, functional status and dietary intake based on dietary history was assessed
through questionnaire which was administered by face-to-face interview with the subjects. Data were analyzed using SPSS software version 16.0 and Foodworks. The past-year prevalence of falls (falls at least once in the previous 12 months) in this study was 32.9%. The past year prevalence of falls in women (40.2%) was higher than in men (17.4%) (p<0.01). Women who had calcium intake less than 300 mg/d (adjusted OR = 3.07, 95% CI = 1.02-9.24) and protein intake < 1 g/kg body weight (adjusted OR = 3.68, 95% CI = 0.98-13.84) were more likely to have a higher risk of falls. In conclusion, one third of the subjects, especially women in this study had a history of falls. Elderly people should be assessed for calcium and protein intake and those with calcium intake less than 300 mg/day and protein intake less than 1 g/kg body weight should be given intervention to reduce falls risk factor and subsequent fall-related co-morbidity.
Keywords: Elderly patients; falls; nutritional status

Matched MeSH terms: Inpatients
Prevalence of Severe Mental Illness Dual Diagnosis Among Inpatients in a Psychiatric Hospital in Malaysia

Subramaniam S, Yee A, Bin Amer Nordin AS, Bin Khalib AQ

J Dual Diagn, 2020 12 12;17(1):4-12.
PMID: 33308058 DOI: 10.1080/15504263.2020.1854410

OBJECTIVE: The aim of this study was to determine the prevalence of alcohol or non-alcohol substance use dual diagnosis among inpatients with severe mental illness in a psychiatric institution in Malaysia. In addition, this study aimed to determine adverse outcomes between dual diagnosis versus single diagnosis. Methods: This was a cross-sectional study conducted in the inpatient ward using the Mini-International Neuropsychiatric Interview (MINI) to establish the diagnosis of severe mental illness and to screen for alcohol or non-alcohol substance use disorder comorbidity. Outcomes and severity of different domains among severe mental illness patients were assessed using the Addiction Severity Index (ASI). Results: Out of 152 patients who participated in this study, 51.3% (n = 78) had comorbid alcohol use disorder, and 29.6% (n = 45) had non-alcohol substance use disorder. Males with Kadazan ethnicity with severe mental illness and alcohol use disorder had a higher risk of having comorbid non-alcohol substance use disorder. Similarly, male Kadazan patients with severe mental illness and non-alcohol substance use disorder had a higher risk of having a comorbid alcohol use disorder. Dual diagnosis patients with alcohol and non-alcohol substance use disorder had higher rates of hospitalizations (p < .001 and p = .001). Family and social relationships were affected among the alcohol use disorder group as shown by the higher composite score for family status (FCOMP; p < .001). This group also showed more severe psychiatric status, as the composite score for psychiatric status (PCOMP) was high (p = .004). Suicidality was higher among patients with alcohol use disorder and severe mental illness (p < .001). Conclusions: The prevalence of severe mental illness dual diagnosis was high in this study with poorer outcomes, higher rates of admissions, and risk of suicidality. This highlights the importance of provisions for a more holistic treatment approach among patients with dual diagnosis.

Matched MeSH terms: Inpatients
Fulltext The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials

Kow CS, Hasan SS

Eur J Clin Pharmacol, 2021 Aug;77(8):1089-1094.
PMID: 33532896 DOI: 10.1007/s00228-021-03087-z

OBJECTIVE: We aimed to perform a meta-analysis of randomized controlled trials (RCTs) to summarize the overall effect of tocilizumab on the risk of mortality among patients with coronavirus disease 2019 (COVID-19).
METHODS: We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, and medRxiv (preprint repository) databases (up to 7 January 2021). Pooled effect sizes with 95% confidence interval (CI) were generated using random-effects and inverse variance heterogeneity models. The risk of bias of the included RCTs was appraised using version 2 of the Cochrane risk-of-bias tool for randomized trials.
RESULTS: Six RCTs were included: two trials with an overall low risk of bias and four trials had some concerns regarding the overall risk of bias. Our meta-analysis did not find significant mortality benefits with the use of tocilizumab among patients with COVID-19 relative to non-use of tocilizumab (pooled hazard ratio = 0.83; 95% CI 0.66-1.05, n = 2,057). Interestingly, the estimated effect of tocilizumab on the composite endpoint of requirement for mechanical ventilation and/or all-cause mortality indicated clinical benefits, with some evidence against our model hypothesis of no significant effect at the current sample size (pooled hazard ratio = 0.62; 95% CI 0.42-0.91, n = 749).
CONCLUSION: Despite no clear mortality benefits in hospitalized patients with COVID-19, tocilizumab appears to reduce the likelihood of progression to mechanical ventilation.

Matched MeSH terms: Inpatients
Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

Zhong XM, Wang F, Zhang Q, Ungvari GS, Ng CH, Chiu HFK, et al.

Int Psychogeriatr, 2019 05;31(5):685-691.
PMID: 29212560 DOI: 10.1017/S1041610217002563

ABSTRACTBackground:Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.
METHODS: The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.
RESULTS: The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.
CONCLUSIONS: Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.

Matched MeSH terms: Inpatients

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