DESIGN/METHODOLOGY/APPROACH: This study has been carried out by using a methodology combining an in-depth literature review with a comparison framework, which is called as the "Framework for Comparing Business Process Improvement Methods." The framework is composed of seven dimensions and has been adapted from four recognized, related frameworks. In addition to the in-depth review of related literature and the adapted comparison framework, researchers have conducted several interviews with healthcare BPI practitioners in different hospitals, to attain their opinions of BPI methods and tools used in their practices.
FINDINGS: The main results have indicated that significant improvements have been achieved by implementing BPIMs in the healthcare domain according to related literature. However, there were some shortfalls in the existing methods that need to be resolved. The most important of these has been the shortfall in representing and analyzing targeted domain knowledge during improvement phases. The tool currently used for representing the domain, specifically flowcharts, is very abstract and does not present the domain in a clear form. The flowchart tool also fails to clearly present the separation of concerns between business processes and the information systems processes that support a business in a given domain.
PRACTICAL IMPLICATIONS: The findings of this study can be useful for BPI practitioners and researchers, mainly within the healthcare domain. The findings can help these groups to understand BPIMs shortfalls and encourage them to consider how BPIMs can be potentially improved.
ORIGINALITY/VALUE: This researchers of this paper have proposed a comparison framework for highlighting popular BPIMs in the healthcare domain, along with their uses and shortfalls. In addition, they have conducted a deep literature review based on the practical results obtained from different healthcare institutions implementing unique BPIMs around the world. There has also been valuable interview feedback attained from BPI leaders of specific hospitals in Saudi Arabia. This combination is expected to contribute to knowledge of BPIMs from both theoretical and practical points of view.
Methods: A yearly correlation test for a 5-year period was performed to investigate the association between the wholesale and RRP medicine prices declared by the pharmaceutical industry from 2011 to 2015 on the one hand and the consumer wholesale and retail medicine price database on the other hand. The median price ratio (MPR) was calculated by comparing the consumer retail medicine price to its international reference price. The Krukal Wallis test was used to analyse the pricing trend throughout the 5-year period, and factors that might elevate the MPR above 2.5 were modelled using binary logistic regression.
Results: A total of 2527 medicine price data were analysed. There was a strong significant association between medicine prices declared to the PSD and the retail medicine prices in every year of the 5-year period. Moreover, there was no significant increase in retail medicine prices throughout the 5-year period. The medicine types, retail location, type of manufacturer, medicinal indications, declared wholesale and RRPs significantly influenced the consumer MPRs that where > 2.5.
Conclusion: The declared medicine price was found to have a significant association with the consumer retail medicine price. Thus, it may be a useful reference for consumers purchasing medicines in private healthcare settings. However, the government of Malaysia must develop strategies to increase medicine price transparency for price-control mechanisms in the private healthcare sector.
MATERIALS AND METHODS: Fifty-six pregnant women attending the Antenatal Clinic, UMMC for their first antenatal check-up consented and were recruited for this study: 28 subjects with diseased periodontium (test group) and 28 subjects with healthy periodontium (control). The test group underwent nonsurgical periodontal therapy and the control group was given oral hygiene education. Periodontal parameters and CRP levels were evaluated at baseline and 6 weeks. Pregnancy outcome data were recorded from the Antenatal Clinic, UMMC.
RESULTS: Plasma CRP levels in the test group were statistically significantly elevated compared to the control group (8.55 ± 5.28 mg/l vs 5.66 ± 2.91 mg/l). After nonsurgical periodontal therapy, a statistically significant reduction in the CRP level in the test group (2.06 mg/l) along with statistically significant improvement in periodontal status in both groups was observed. The mean birth weight for infants of both groups showed no statistically significant difference.
CONCLUSIONS: Plasma CRP levels in pregnant women with diseased periodontium were statistically significantly reduced after nonsurgical periodontal therapy. However, no association between CRP levels and adverse pregnancy outcome was observed.
Objectives: This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients.
Materials and Methods: This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.
Results: A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity.
Conclusion: There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment.
METHODOLOGY: A cross-sectional study was conducted among 600 students from higher education institutions in Melaka aged between 18 to 30 years old. Multistage sampling of the institutions was performed. Valid and reliable self-administered questionnaire in the national language, Bahasa Malaysia, was used as to collect data on sociodemographic, personal background, knowledge on STIs and sources of information for STIs. Univariate, bivariate and multivariate analyses were conducted using IBM SPSS software version 25.
RESULTS: The response rate for this study was 88%. The mean knowledge score was 24.1 ±5.1 out of 38. HIV was the most known STIs while gonorrhoea, trichomoniasis and chlamydial infections were among the least known STIs. Oral intercourse was the least known sexual activity that could transmit STIs. Higher proportion of respondents had correct knowledge on control and preventive measures of STIs (between 78% and 95%) compared to correct knowledge on sign and symptoms of STIs (between 8.5% and 67.8%). More than 90% of the respondents were unaware that a person infected with STIs could be symptom free. Four variables were identified as the determinants of the knowledge on STIs, which were level of education, place of stay, history of sexual and reproductive health education and involvement in STIs awareness programs (F (4,445) = 11.405, p <0.001, R2 = 0.093).
CONCLUSIONS: The knowledge on STIs among students in higher education institutions was unsatisfactory. The existing sexual education programs can be strengthened by delivering more information on other STIs rather than focusing on HIV only. The future program should focus on students of diploma and/or skill certificate and staying off-campus.
Material and Methods: From an initial number of 10 patients, seven were contactable and available for analysis. All patients underwent PCL and/or PLC reconstruction (modified Larson's procedure) between 2017 and 2019. The mean age of our cohort was 31.4±9.6 years (range, 21 to 46). Assessment of functional outcomes pre- and post-operatively were done using the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). The mean follow-up from operation at time of reporting was seven months (range, 2 to 12 months).
Results: There were four combined PCL and PLCs, two isolated PLCs and one patient who underwent an isolated PCL reconstruction. There were significant improvements between pre-operative and post-operative in all functional outcome scores utilised following PCL reconstruction and/or modified Larson's reconstruction. Lysholm knee scoring scale improved from pre-operative to post-operative at 41.14±12.32 to 74.86±13.52 (p=0.0001), KOOS from 49.71±11.19 to 71.43±13.84 (p=0.001), and VAS from 5.71±2.06 to 2.86±2.48 (p=0.001). Our sub-analysis showed that higher functional outcomes were present when surgery was done less than six months from the time of index injury. There were no complications (eg. Infections, revisions) in this cohort at the time of reporting.
Conclusion: Reconstructive surgery for PCL and/or PLC injury is successful in increasing the functional outcomes of patients post-operatively. Delays from injury to surgery remains a problem in the public setting as patients may need to await appropriate imaging and approval of funding. Increased awareness for early surgical intervention may improve overall outcomes of PCL and/or PLC reconstruction in Malaysia.