Displaying publications 61 - 80 of 266 in total

  1. Chew KS, Noredelina MN, Ida ZZ
    Med J Malaysia, 2015 Jun;70(3):162-8.
    PMID: 26248779 MyJurnal
    INTRODUCTION: Aimed at providing integrated multi-level crisis intervention to women experiencing violence such as rape, One Stop Crisis Centre (OSCC) in Malaysia is often located in the emergency department. Hence, it is imperative that emergency department healthcare providers possess adequate knowledge and acceptable attitudes and practices to ensure the smooth running of an efficient OSCC work process.

    METHOD: To study the knowledge, attitude and practice of rape management in OSCC among four groups of healthcare providers in the emergency department [i.e., the emergency medicine doctors (EDs), the staff nurses (SNs), the medical assistants (MAs) and the hospital attendants (HAs)], a selfadministered questionnaire in the form of Likert scale was conducted from January to October 2013. Correct or favourable responses were scored appropriately.

    RESULTS: Out of the 159 participants invited, 110 responded (69.2% response rate). As all data sets in the Knowledge, Attitude and Practice sections are non-parametric, Kruskal- Wallis test was performed. Homogeneity of variance was verified using non-parametric Levene test. In all three sections, there are statistically significant differences in scores obtained among the four groups of healthcare providers with H(3) = 16.0, p<0.001 for Knowledge, H(3) = 27.1, p<0.001 for Attitude and H(3) = 15.8, p<0.001 for Practice sections. Generally, the SNs obtained the highest mean rank score in the knowledge and practice sections but the EDs obtained the highest mean rank score in the attitude section. Some of the responses implied that our healthcare providers have the victim-blaming tendency that can negatively impact the victims.

    CONCLUSION: Healthcare providers must not only have adequate knowledge but also the non-judgemental attitude towards victims in OSCC.
    Matched MeSH terms: Emergency Service, Hospital
  2. Chan CYW, Vivek AS, Leong WH, Rukmanikanthan S
    Malays Orthop J, 2008;2(2):27-30.
    The goal of treatment in distal radius fracture is to restore the anatomy of the distal radius, however the criteria currently used to evaluate the quality of eduction are based on Western based published figures. This goal of this study was to investigate whether there are variations in the morphology of the distal radius among the multiracial population of Malaysia. Consecutive normal wrist radiographs of patients who presented to the accident and emergency unit in three major hospitals in Malaysia were measured. The palmar tilt of the distal radius averaged 12.6o ± 3.55o, and the radial inclination averaged 25.1o ± 3.42o. The ulnar variance averaged – 0.1 ± 1.31mm, 38.4% of the patients had neutral ulnar variance, 28.8% have negative ulnar variance and 32.9% have positive ulnar variance. Our results indicate that distal radius morphometric parameters in the Malaysian population are comparable to Western figures.
    Matched MeSH terms: Emergency Service, Hospital
  3. Subramaniam T, Loo RCN, Poovaneswaran S
    Background: This cross sectional study was done to identify the areas of lack of knowledge, practice and awareness of students about the effective use of personal protective equipment (PPE).
    Methods: A total of 40 students were selected when they were posted to the accident and emergency unit (A&E) in Seremban Hospital; all of them answered a questionnaire and were observed unaware on the effective use of PPE in the A&E.
    Results: We found that 17.5% of students were unaware of the right technique of removing the gloves after a procedure and 25% of students were unaware of safety of hand washing. During invasive procedures, 12.5 % of students did not wash their hands before invasive procedures, 65% did not wear aprons and 57.5% did not wear masks. During non- invasive procedures more than 25% of students did not wash hands before or after the procedures.
    Conclusion: There is still significant lack of knowledge in students about the effective use of PPE that needs to be addressed.
    Keywords: PPE, Personal protective equipment, effective practice of PPE, A&E
    Matched MeSH terms: Emergency Service, Hospital
  4. Rahman NH, Rainis R, Noor SH, Syed Mohamad SM
    World J Emerg Med, 2016;7(3):213-20.
    PMID: 27547282 DOI: 10.5847/wjem.j.1920-8642.2016.03.009
    BACKGROUND: The main aim of this study is to utilize the geographical information system (GIS) software and perform the spatial analysis in relation to clinical data for road traffic injury (RTI) pediatric cases attending the emergency department.
    METHODS: The study sample included pediatric patients (age less than 18 years) with road-related injuries within a district in Malaysia who attended emergency departments of two tertiary hospitals within the district. In addition to injury, pre-hospital care and outcome data, the coordinate of the locations were obtained by the ambulance paramedics by using portable handheld GPS unit brand Garmin(®) model GPS 72 H. The data was transferred into the excel format which in turn underwent GIS analysis by using ARCGIS(®) (by ESRI) software version 10.1 licensed to the study institution.
    RESULTS: A total of 102 (24.8%) of all motor vehicle crash (MVC) victims involved the pediatric age group (age 18 years and below). The mean (SD) age of the pediatric victims was 14.30 years (SD 3.830). Male comprised of 68 (66.7%) of the cases. Motorcyclists [88 (88.0%)] were the most common type of victims involved. Interestingly, the majority of the severely injured victims [75 (73%)] sustained the RTI on roads with maximum speed limit of 60 km/hour. The mean (SD) length of hospital stay was 7.83 days (5.59).
    CONCLUSION: The pediatric related road traffic injury in Malaysia causes significant health and social burden in the country. This study showed both important clinical and geographical factors that need to be taken into consideration for future preventive action.
    KEYWORDS: Geographical information system; Geospatial; Injury; Pediatric; Road safety
    Matched MeSH terms: Emergency Service, Hospital
  5. Natasha MN, Khoo HW, Sulaiman AS, Nur Azurah AG, Md Dali AZH, Jamil MA
    Medicine & Health, 2012;7(2):107-111.
    Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.
    Matched MeSH terms: Emergency Service, Hospital
  6. Nazziwa Aisha, Mohd Bakri Adam, Shamarina Shohaimi, Aida Mustapha
    The source of gastrointestinal bleeding (GIB) remains uncertain in patients presenting without hematemesis. This paper aims at studying the accuracy, specificity and sensitivity of the Naive Bayesian Classifier (NBC) in identifying the source of GIB in the absence of hematemesis. Data of 325 patients admitted via the emergency department (ED) for GIB without hematemesis and who underwent confirmatory testing were analysed. Six attributes related to demography and their presenting signs were chosen. NBC was used to calculate the conditional probability of an individual being assigned to Upper Gastrointestinal bleeding (UGIB) or Lower Gastrointestinal bleeding (LGIB). High classification accuracy (87.3 %), specificity (0.85) and sensitivity (0.88) were achieved. NBC is a useful tool to support the identification of the source of gastrointestinal bleeding in patients without hematemesis.
    Matched MeSH terms: Emergency Service, Hospital
  7. Oo KT, Mohd-Zain MR, Shatriah I
    Cureus, 2018 Jan 29;10(1):e2128.
    PMID: 29607276 DOI: 10.7759/cureus.2128
    Central retinal arterial occlusion is an ocular emergency. Central retinal artery occlusion following cardiac procedures have been described in adults. We describe a pediatric patient who developed central retinal artery occlusion following pulmonary artery stenting. It is important to highlight this potential risk to ensure early diagnosis and prompt treatment.
    Matched MeSH terms: Emergency Service, Hospital
  8. Idrose AM
    Acute medicine & surgery, 2015 07;2(3):147-157.
    PMID: 29123713 DOI: 10.1002/ams2.104
    Thyroid hormones affect all organ systems and, in excess, can cause increased metabolic rate, heart rate, ventricle contractility, and gastrointestinal motility as well as muscle and central nervous system excitability. Thyroid storm is the extreme manifestation of thyrotoxicosis with an estimated incidence of 0.20 per 100,000 per year among hospitalized patients in Japan. The mortality of thyroid storm without treatment ranges from 80% to 100%; but with treatment, the mortality rate is between 10% and 50%. The diagnostic strategy for thyroid storm may take into consideration Burch-Wartofsky scoring or Akamizu's diagnostic criteria. Multiple treatment aims need to be addressed in managing thyroid storm effectively. This paper puts together all aspects to be considered for the management of hyperthyroidism and thyroid storm during the acute and emergency phase as well as consideration of special populations.
    Matched MeSH terms: Emergency Service, Hospital
  9. Othman IA, Hashim ND, Nazimi AJ
    Case Rep Med, 2018;2018:4053531.
    PMID: 29861735 DOI: 10.1155/2018/4053531
    The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.
    Matched MeSH terms: Emergency Service, Hospital
  10. Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, et al.
    World J Emerg Surg, 2017;12:29.
    PMID: 28702076 DOI: 10.1186/s13017-017-0141-6
    Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
    Matched MeSH terms: Emergency Service, Hospital
  11. Michal, C.S., Nadirah, S., Juhanah, G., Praneetha, P., Mohan, G.
    The Emergency Department (ED) provides treatment for acutely ill patients in need of urgent medical attention. Despite the availability of the primary care unit ‘Klinik Kesihatan’, where non urgent patients should be treated, Malaysia’s public hospitals still need to deal with overcrowding of non-urgent patients in ED. The main aim of the study was to assess the willingness of non-urgent patients to be redirected to Klinik Kesihatan. This was a cross-sectional study conducted at Hospital Tuaran Emergency Department, Sabah. Non-urgent patients were interviewed using a questionnaire, to find out the purpose of their visit to Emergency Department. A total of 318 non-urgent patients out of 457 patients were interviewed during the study duration. 41 respondents (12.9%) were willing to be redirected towards a Klinik Kesihatan. No associated factors were found when compared with the unwilling to be redirected group. Among 277 respondents who rejected redirection to Klinik Kesihatan, 70.4% agreed to pay a surcharge to be treated in the Emergency Department and there was no association found with the employment status (p= 0.391). Most patients were not willing to accept redirection to a Klinik Kesihatan and would prefer to visit the Emergency Department despite knowing that their condition or illness is one that does not require emergency treatment. Social media, advertisements and pamphlets must be made available to educate patients on the proper use of the Emergency Department.
    Matched MeSH terms: Emergency Service, Hospital
  12. Syed Farid Almufazal Syed Salim, Shamsuriani Md Jamal
    FascicularVentricular Tachycardia (VT) is a uniqueclinical syndrome, rarelyencountered by physicians.It isalso known as BelhassenSyndrome, named after a physician who reported the case in 1981. The condition,accounts for 10-15% of total idiopathic VTand the rhythm is sensitive tocalcium channel blocker. First described in 1979, the diagnosis of thissyndromeremains challenging,as the electrocardiogram (ECG) changes may be incorrectly diagnosed as Supraventricular Tachycardia (SVT) with aberrant conductions. We describeda patient whopresented to Emergency Department with palpitation. The difficulty in diagnosis and management is illustrated in the reportas he was initially misdiagnosed as SVT with resistance to initial standard treatment.This case report alsodescribedwide complex tachycardia algorithms to assist physician in daily clinicalpractice. Therapeutic options inmanaging this rare syndrome werealso discussed.
    Matched MeSH terms: Emergency Service, Hospital
  13. Samsudin I, Vasikaran SD
    Clin Biochem Rev, 2017 Apr;38(2):59-68.
    PMID: 29332972
    Procalcitonin (PCT), regarded as a biomarker specific for bacterial infections, is used in a variety of clinical settings including primary care, emergency department and intensive care. PCT measurement aids in the diagnosis of sepsis and to guide and monitor antibiotic therapy. This article gives a brief overview of PCT and its use in guiding antibiotic therapy in various clinical settings, as well as its limitations. PCT performance in comparison with other biomarkers of infection in particular CRP is also reviewed. Owing to its greater availability, CRP has been widely used as a biomarker of infection and sepsis. PCT is often reported to be more superior to CRP, being more specific for sepsis and bacterial infection. PCT starts to rise earlier and returns to normal concentration more rapidly than CRP, allowing for an earlier diagnosis and better monitoring of disease progression.
    Matched MeSH terms: Emergency Service, Hospital
  14. Huan NC, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA
    Respirol Case Rep, 2020 Dec;8(9):e00684.
    PMID: 33194207 DOI: 10.1002/rcr2.684
    Tracheobronchial stenosis due to tuberculosis (TSTB) is a potentially debilitating complication of endobronchial tuberculosis (EBTB). Endobronchial interventions including silicone stent insertion is an acceptable approach to improve quality of life among patients with TSTB. However, little is known about the optimal management strategy for patients with bronchomalacia secondary to EBTB (B-EBTB) and whether stent-related complication rates are higher among this group of patients. Herein, we report two patients with B-EBTB who unfortunately developed bronchial tear related to silicone endobronchial stenting. Both patients were successfully managed conservatively without the need for emergency open surgery. We hypothesize that endobronchial intervention might be more beneficial for patients with pure TSTB and might be riskier in cases of bronchomalacia with reduced airway thickness and loss of airway cartilaginous support. More future studies are needed to bridge the current gap in knowledge regarding the optimal management and role of endobronchial interventions among patients with B-EBTB.
    Matched MeSH terms: Emergency Service, Hospital
  15. Mohd Khairi, A.L., Nik Azlan, N.M., Faizal Amri, H.
    Medicine & Health, 2018;13(1):198-207.
    This study determined factors that influence usage of automated external defibrillation (AED) on out-of-hospital cardiac arrest among paramedics in Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a cross sectional prospective study conducted between December 2013 and January 2014. Paramedics from Emergency Department were enrolled and assessed using the self-filled questionnaire consisting of multiple sections including knowledge assessment, training and practice. In total, 53 paramedics participated in this study. Only 62% participants used AEDs previously. Not more than 83% participants admitted that they would use it if required. A positive correlation was observed between age and work experience with knowledge on AED usage (p=0.001 and p=0.005, respectively). Government’s institute graduates possess better knowledge and higher confidence level than private institutions graduates (p
    Matched MeSH terms: Emergency Service, Hospital
    This qualitative descriptive study, underpinned by naturalistic inquiry, explored the prehospital emergency medical service response time in Klang Valley by providing an in-depth information of the phenomenon. In this study, various levels of health care personnel participated in focus group discussion and semi-structured interview. The staff members consisted of many levels of category from the lower ranks up to the higher level administrative officers. Content analysis was employed in analysing all data. Every one of the key informants was aware of the importance of making immediate responses to each ambulance call received. They shared their thoughts, experiences, and challenges in achieving the ideal response time in line with international recommendations. There were five categories of issues that emerged and challenges that arose from delays in response time, namely, 1) insufficient key information; 2) inconsistent information leading to delayed arrival of ambulance; 3) traffic condition causing delay in ambulance speed; 4) lack of resources contributing to an increase in workload; and, 5) unassertiveness in the attitude of members of staff. The findings have provided an answer to the society with regard to the current pre-hospital emergency medical service issues related to delay in the service delivered. Thus, policy makers and pre-hospital health care service providers should develop a strategic action plan by focusing on these findings to reduce the response time of ambulance call.
    Matched MeSH terms: Emergency Service, Hospital
  17. Fidelia Ferderik Anis, Mazlinda Musa, Aini Ahmad
    Introduction:Simulation training in airway management among nursing students was recommended to enhance skills, knowledge and confidence during their clinical attachment in the Emergency Department but the efficacy was not being explored adequately. The objective of this study was to determine the efficacy of simulation training in airway management among final year nursing student Kota Kinabalu Training Institute (KKTI). Methods: This was quasi-experimental research design, which the participant was divided into test and control group without random-ization. A sample of forty final year nursing students was selected for this study. This was a comparative study in-volving twenty KKTI final year nursing students (test group) with simulation versus twenty final year nursing students (control group) without simulation on airway before and after posted to Emergency and Trauma Department (ETD). Two instruments were used, i) Pretest/posttest survey design by Porter et al (2013), and; ii) The Simulation Efficacy Tool-Modified (SET-M). SPSS version 24 Independent T test was used to analyse the mean score between the groups. Results: Levene’s test for equality of variance shown significant (t= -.005, df = 38, p
    Matched MeSH terms: Emergency Service, Hospital
  18. Mohamad N, Abd Halim NN, Ahmad R, Baharuddin KA
    Malays J Med Sci, 2009 Apr;16(2):33-7.
    PMID: 22589656 MyJurnal
    Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.
    Matched MeSH terms: Emergency Service, Hospital
  19. Ahmad R, Nik Abdul Rahman NH, Mohd Noh AY, Nik Abdul Rahman NA, Mohamad N, Baharudin KA
    Malays J Med Sci, 2010 Jan;17(1):38-43.
    PMID: 22135524 MyJurnal
    The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management.
    Matched MeSH terms: Emergency Service, Hospital
  20. Lim BJV, Wahab SFA, Kueh YC
    Malays J Med Sci, 2020 Mar;27(2):90-100.
    PMID: 32788845 DOI: 10.21315/mjms2020.27.2.10
    Background: The study aimed to examine the reliability and validity of the existing three-tier triaging system and a new five-level emergency triaging system, emergency severity index (ESI), in the Emergency Department (ED) of Hospital Universiti Sains Malaysia (HUSM).

    Methods: This study was conducted in HUSM's ED over two study periods. In the first three months, 300 patients were triaged under the three-tier triaging system, and, in the subsequent three months, 280 patients were triaged under the ESI. The patients were triaged by junior paramedics and the triage records were retained and later re-triaged by senior paramedics. The inter-rater reliability was evaluated using Cohen's Kappa statistics. The acuity ratings of the junior paramedics were compared with those of the expert panel to determine the sensitivity and specificity of each acuity level for both the ESI and the three-tier triaging system. The over-triage rate, under-triage rate, amount of resources used, admission rate and discharge rate were also determined.

    Results: The inter-rater agreement for the three-tier triaging system was 0.81 while that of the ESI was 0.75. The ESI had a higher average sensitivity of 74.3% and a specificity of 94.4% while the three-tier system's average sensitivity was 68.5% and its specificity 87.0%. The average under-triage and over-triage rates for the ESI were 10.7% and 6.2%, respectively, which were lower than the three-tier system's average under-triage rate of 13.1% and over-triage rate of 17.1%. The urgency levels of both the ESI and the three-tier system were associated with increased admission rates and resources used in the ED.

    Conclusion: The ESI's inter-rater reliability was comparable to the three-tier triaging system and it demonstrated better validity than the existing three-tier system.

    Matched MeSH terms: Emergency Service, Hospital
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