Displaying publications 61 - 80 of 2936 in total

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  1. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review
    Tan VES
    Am J Otolaryngol, 2011 Jan-Feb;32(1):62-8.
    PMID: 20031268 DOI: 10.1016/j.amjoto.2009.10.002
    Objective: Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.
    Methods: The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.
    Results: All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.
    Conclusion: Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.
    Matched MeSH terms: Hospitals, General
  2. Fulltext Global childhood unintentional injury study: multisite surveillance data
    He S, Lunnen JC, Puvanachandra P, Amar-Singh, Zia N, Hyder AA
    Am J Public Health, 2014 Mar;104(3):e79-84.
    PMID: 24432924 DOI: 10.2105/AJPH.2013.301607
    We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan).
    Matched MeSH terms: Hospitals, Urban
  3. Occurrence, Management, and Risk Factors for Adverse Drug Reactions in Multidrug Resistant Tuberculosis Patients
    Ahmad N, Javaid A, Syed Sulaiman SA, Afridi AK, Zainab, Khan AH
    Am J Ther, 2016 3 5;25(5):e533-e540.
    PMID: 26938643 DOI: 10.1097/MJT.0000000000000421
    Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about prevalence, management, and risk factors for adverse drug reactions (ADRs) in MDR-TB patients in Pakistan. To evaluate occurrence, management, and risk factors for ADRs in MDR-TB patients, and its impact on treatment outcomes, this observational cohort study was conducted at programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar, Pakistan. A total of 181 MDR-TB patients enrolled at the study site from January 1, 2012 to February 28, 2013 were included. Patients with drug resistant TB other than MDR-TB, transferred out patients and those who were still on treatment at the end of study duration (January 31, 2015) were excluded. Patients were followed until treatment outcomes were reported. ADRs were determined by laboratory data and/or clinical criteria. SPSS 16 was used for data analysis. A total of 131 patients (72.4%) experienced at least 1 ADR. Gastrointestinal disturbance was the most commonly observed adverse event (42%), followed by psychiatric disturbance (29.3%), arthralgia (24.3%), and ototoxicity (21%). Potentially life-threatening ADRs, such as nephrotoxicity (2.7%) and hypokalemia (2.8%) were relatively less prevalent. Owing to ADRs, treatment regimen was modified in 20 (11%) patients. On multivariate analysis, the only risk factor for ADRs was baseline body weight ≥ 40 kg (OR = 2.321, P-value = 0.013). ADRs neither led to permanent discontinuation of treatment nor adversely affected treatment outcomes. Adverse effects were prevalent in current cohort, but caused minimal modification of treatment regimen, and did not negatively impact treatment outcomes. Patient with baseline body weight ≥ 40 kg should be closely monitored.
    Matched MeSH terms: Hospitals
  4. Perioperative anaphylaxis: A five-year review in a tertiary paediatric hospital
    Toh TS, Foo SY, Loh W, Chong KW, En Goh A, Hee HI, et al.
    Anaesth Intensive Care, 2021 Jan;49(1):44-51.
    PMID: 33472385 DOI: 10.1177/0310057X20964470
    Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four-15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin (n = 3), atracurium (n = 1) and rocuronium (n = 1). Three patients (25.0%) had non-IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.
    Matched MeSH terms: Hospitals, Pediatric
  5. The treatment of malaria in glucose-6-phosphate dehydrogenase deficient patients in Sabah
    Khoo KK
    Ann Trop Med Parasitol, 1981 Dec;75(6):591-5.
    PMID: 7325735 DOI: 10.1080/00034983.1981.11687489
    One hundred and nine (9·8%) out of 1103 malaria patients examined in Sabah were deficient in glucose-6-phosphate dehydrogenase (G6PD). Sixty-nine of these G6PD-deficient patients were randomly allocated to one of three treatment regimes with (a) chloroquine, (b) chloroquine and primaquine or (c) sulfadoxine-pyrimethamine (Fansidar). No haemolysis was observed in group (a); except for a single mild case, no haemolysis was seen in group (c). However, in the primaquine group (23 patients), haemolysis occurred in seven of the 16 patients who had complete G6PD deficiency. Of these seven, five required blood transfusion and the other two developed acute renal failure, one requiring peritoneal dialysis. In the Fansidar group (c), four of the 22 patients took more than 15 days to clear the parasitaemia. Chloroquine resistance to falciparum infection was common in the patients given this anti-malarial.
    Study site: Queen Elizabeth Hospital, Kola Kinabalu, Sabah, Malaysia
    Matched MeSH terms: Hospitals, General
  6. Fulltext Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria
    Oche OM, Sadiq UA, Oladigbolu RA, Chinna K
    Ann Afr Med, 2018;17(3):125-132.
    PMID: 30185681 DOI: 10.4103/aam.aam_39_17
    BACKGROUND: In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries.

    AIM: This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria.

    METHODOLOGY: This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital.

    RESULTS: Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss.

    CONCLUSION: Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.

    Matched MeSH terms: Hospitals, Teaching
  7. Fulltext Pilomatrixoma of the cheek- a case report
    Mohd Tahir MKA, Ramanathan A, Foo GBT, Gopalan S, Zainal Abidin M, Abdul Rahman F
    Ann Dent, 2020;27(1):28-32.
    MyJurnal
    Pilomatrixoma is a relatively common benign tumour arising from the matrix and inner sheath of a normal hair follicle as well as hair cortex. It is usually presented as a superficial, solitary, firm mass which is asymptomatic and slowly growing. It accounts for about 0.2% of all routine skin specimens and may poses a diagnostic challenge as it may resemble other common benign lesions found in the head and neck region. We report a case of a 33-year old men presented to us with a pilomatrixoma of the right cheek, surgical management and histological findings.
    Matched MeSH terms: Hospitals, General
  8. Fulltext Cleft Lip And Palate Centre: The University Hospital Experience
    Ghani, S.H.A., Hussain, R., Hassan, S., Tan, K.K., Ahmad, M.H.
    Ann Dent, 1996;3(1):-.
    MyJurnal
    The Combined Cleft Clinic at the University Hospital, Kuala Lumpur was organised in 1992. The team consists of Plastic Surgeon, Orthodontists, Speech therapist, Ear, Nose and Throat Surgeon, Audiologist, medical officers and the nurses. We attend the clinic on a regular basis. Specialists from other medical and dental disciplines as well as the members of the Cleft Lip and Palate Association of Malaysia (CLAPAM) do occasionally participate in this set-up.The team members formulate treatment plans for each cleft patient, monitor the patient's growth and development and manage the patient at different stages according to the individual needs. To date, the idea of team approach and an establishment of a centre towards management of cleft patients seem to be the most ideal as the patients are benefiting total treatment and care from various specialists from only one place. The experience of University Hospital as a centre for cleft patients is discussed.
    Matched MeSH terms: Hospitals, University
  9. Fulltext Beta carotene intake and oral cancer risk
    Ng LC, Helen, Razak IA, Ghani WMN, Marhazlinda J, Rahman ZAA, Norlida A, et al.
    Ann Dent, 2015;22(1):2-5.
    MyJurnal
    This study aims to identify the relationship between dietary intakes of β-carotene with risk of oral cancer.
    Methods: A hospital-based, case-control study was conducted on 306 Malaysians who seek treatment at participating centres/hospitals. Subjects selected from the Malaysian Oral Cancer Data and Tissue Banking System (MOCDTBS) consisted of 153 cases and 153 controls that were matched for gender, age (±5 years) and ethnicity. Food consumption was measured using Food Frequency Questionnaire (FFQ). NutrieMart Version 2.0.0 software was used to estimate daily nutrient of each subject from the FFQ. Logistic Regression analysis was conducted to compute the odds ratio (OR) for intakes of β-carotene and oral cancer risk.
    Results: Intake of β-carotene was found to be not associated with risk of oral cancer (OR 0.83, 95%CI: 0.42-1.66, p>0.05).
    Conclusion: No significant association was found between dietary intakes of β-carotene with oral cancer risk in this study population.
    Matched MeSH terms: Hospitals
  10. Fulltext Oral health related quality of life and periodontal status of a selected Malaysian adult population: a pilot study
    Abdullah, N.S., Radzali, N.F.M., Saub, R., R.D. Vaithilingam,
    Ann Dent, 2013;20(2):16-23.
    MyJurnal
    To assess the oral health related quality of life
    (OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
    Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
    Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
    Matched MeSH terms: Hospitals, University
  11. Fulltext Developing a caries risk assessment model for patients attending University Malaya dental clinic
    Asma, M., Ho, S.L., Yong, J.S., Nor, N.A.M., Yusof, Z.Y.M.
    Ann Dent, 2013;20(2):9-14.
    MyJurnal
    In response to the introduction of an integrated dental education program at University of Malaya (UM) in 2011, a study was conducted to develop a caries risk assessment model (CRA) for use in non-surgical caries management for Year 3 and 4 students of the new integrated program. Methods: The CRA model was based on risk indicators used by dental students in the Preventive Dental Clinic (PDC). Patients aged 15 years and above who attended the PDC for the first time in year 2009 and 2010 were used as study sample. Four hundred and fourteen patient names were identified from the student PDC logbook. Of the 414, 359 dental records had complete data and included in the analysis. Data were analysed using SPSS version 17.0. Chi-square test was used for group comparison and associated factors for coronal caries were analysed using Multiple Logistic Regression (MLR). Results: The final model showed that adults, brushing teeth once daily, and not having dental prosthesis/appliance were 3.31 (CI=1.64-6.69), 2.53 (CI=1.19-5.40), and 2.25 (CI=1.25-4.10) more likely to develop coronal caries, respectively, than adolescents, brushing teeth at least twice a day, and having dental prosthesis/appliance. Conclusions: The results indicate that age group, toothbrushing frequency and dental prosthesis status are significant indicators for coronal caries among patients. Outcomes of the study contributed towards bridging the gap between cariology
    and preventive modules in the new integrated dental program.
    Matched MeSH terms: Hospitals, University
  12. Fulltext The Contribution of Forensic Odontology in the Highland Towers Condominium Disaster
    Sharifah F. Alhabshi, Nambiar, Pharabhakaran
    Ann Dent, 1995;2(1):-.
    MyJurnal
    An apartment complex collapsed in Malaysia killing 48 people trapped inside.The dental disaster victim identification team comprising of officers from the Kuala Lumpur General Hospital, Armed Forces and the Dental
    Faculty, University of Malaya played a very active role in the identification process. Most of the bodies were badly decomposed and some grossly disfigured. Problems were encountered due to inadequate facilities and
    equipments at the mortuary.Difficulties were also encountered during the procurement and deciphering of information from dental records. Suggestions have been made to improve facilities, expertise and also to create awareness amongst dentists to ensure proper recording of their patients' dental status.
    Matched MeSH terms: Hospitals, General
  13. Fulltext Awareness and knowledge of smoking and periodontitis among dental patients
    Sadikin AS, Mansor H, Saub R, Vaithlingam RD
    Ann Dent, 2015;22(2):15-22.
    MyJurnal
    Objective: This study aimed to assess the awareness of periodontal disease and level of knowledge of the relationship between smoking and periodontal disease amongst subjects who were smokers verses non-smokers.
    Methods: A questionnaire looking at knowledge of respondents regarding gum disease and knowledge and awareness about oral impacts of smoking on periodontal disease was developed and pretested in Dental Faculty University of Malaya. Basic Periodontal Examination (BPE) index was used to assess periodontal status.
    Results: The questionnaire was answered by 130 subjects. Prevalence of smoking was 14.6%. A total of 58.6% non-smokers and 57.9% smokers knew about periodontal disease. However, only 26.1% non-smokers and 10.5% smokers knew that the cause for periodontal disease was plaque. More non-smokers than smokers knew that smoking affected periodontal health (80.2% and 68.4% respectively) (p>0.05) and tooth mobility was an effect of smoking on periodontal health (27.0% and 0%) (p<0.05). Regarding source of information on effect of smoking on periodontal health, 63.2% smokers and 63.1% non-smokers reported obtaining information through the mass media. However, only 31.6% smokers and 28.8% non-smokers were informed by their dentist.
    Conclusion: The awareness of periodontal disease and knowledge of the relationship between smoking and periodontal disease was low in this selected population of smokers and non-smokers.
    Keywords: Awareness, knowledge, periodontitis, smoking
    Study site: Primary Care Unit, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
    Matched MeSH terms: Hospitals, University
  14. Fulltext Satisfaction of patient in undergraduate periodontal clinic at University of Malaya
    Abdul Ghani, M., Mohd Zaki, M.H., Cheah, C.W.
    Ann Dent, 2015;22(2):38-44.
    MyJurnal
    The aim of study was to evaluate the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 of University of Malaya. The subjects were patients treated in the Year 4 periodontology clinic (Polyclinic B) (n=38) and Year 5 periodontology clinic (Polyclinic C) (n=30). Data was gathered using a questionnaire which consisted of 4 components namely appointment facilities, infrastructure and basic facilities, behaviour of students dental clinician, and quality and efficiency of treatment provided. The results showed that for appointment facilities the level of satisfaction was almost 80%; for infrastructure and basic facilities the satisfaction was more than 85%; for behavior of students dental clinician the level of satisfaction was more than 90% and for quality and efficiency of treatment provided the level of satisfaction was more than 60%. When all the components were compared between patients treated in Polyclinic B to patients treated in Polyclinic C, there was no statistically significant difference (p>0.05). In conclusion, the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 periodontology clinic of University of Malaya is the same
    Matched MeSH terms: Hospitals, University
  15. Fulltext A clinical study of oral mucosal changes adjacent to amalgam restorations
    Lee, A.T., Lai, L.W., Goh, Y.C., Chan, S.W., Siar, C.H.
    Ann Dent, 2017;24(1):10-18.
    MyJurnal
    Amalgam has been widely used in dentistry and its components may cause some oral mucosal changes (OMC), commonly presenting as oral lichenoid lesions (OLLs), acute or generalized sensitivity reaction or amalgam tattoo. Our objective was to determine the demographic and clinical profile of patients with and without OMC adjacent to their amalgam restorations (AR) and to evaluate the prevalence and types of AR-related OMC and associated clinical parameters. Materials and methods: In this retrospective crosssectional study, 83 outpatients attending the Primary Dental Care Unit at the Faculty of Dentistry, University Malaya were examined for the presence of AR-related OMC. The study period was from early to mid July 2016. Firstly, patients’ personal details (age, gender, medical status, social habits) were analyzed and history of AR (the age, condition and number of restorations) was determined. Clinical examination of patient’s oral cavity was carried out to detect any AR-related OMC. The data collected was analyzed using SPSS 12.0.1 Result: Approximately 14.6 % patients had OMC. OLLs and amalgam tattoo made up 1.2% and 13.4% respectively. Females (8.4%) had higher predilection and Chinese were more commonly affected (8.4%). Social habits were not associated with OMC. Certain systemic diseases, age (p=0.005) and duration of amalgam (p=0.007) in the oral cavity were significant risk factors for OMC. Conclusions: Present findings suggest that AR-related OMC is uncommon. Three key parameters namely systemic diseases, patient’s age and duration of AR were identified as significant risk factors predisposing to the development of OMCs.
    Matched MeSH terms: Hospitals, University
  16. Fulltext Methicillin-resistant Staphylococcus aureus nosocomial infection trends in Hospital Universiti Sains Malaysia during 2002-2007
    Al-Talib HI, Yean CY, Al-Jashamy K, Hasan H
    Ann Saudi Med, 2010 Sep-Oct;30(5):358-63.
    PMID: 20697171 DOI: 10.4103/0256-4947.67077
    Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility.
    Matched MeSH terms: Hospitals
  17. Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man
    Al-Jubouri MA, Inkster GD, Nee PA, Andrews FJ
    Ann. Clin. Biochem., 2006 Jul;43(Pt 4):323-5.
    PMID: 16824287 DOI: 10.1258/000456306777695681
    A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.
    Matched MeSH terms: Hospitals
  18. Fulltext Cardiff acne disability index in Sarawak, Malaysia
    Yap FBB
    Ann Dermatol, 2012 May;24(2):158-61.
    PMID: 22577265 DOI: 10.5021/ad.2012.24.2.158
    BACKGROUND: Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown.
    OBJECTIVE: The aim of this study is to determine the impact of acne on quality of life and its relationship with severity.
    METHODS: A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia.
    RESULTS: The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income <1,000 United States Dollor/month had a higher mean CADI (mean 5.5 vs. 4.4; p=0.04). Females, indigenous groups, and patients with tertiary education tended to have more severe CADI impairment (p>0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; p<0.001) but became insignificant for moderate and severe acne.
    CONCLUSION:
    Acne impairment in Sarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.
    KEYWORDS: Acne vulgaris; Disability; Quality of life

    Study site: Dermatology Departments of Sarawak General Hospital
    Matched MeSH terms: Hospitals, General
  19. Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia
    Sethi D, Aljunid S, Saperi SB, Clemens F, Hardy P, Elbourne D, et al.
    Ann Emerg Med, 2007 Jan;49(1):52-61, 61.e1.
    PMID: 17084938
    STUDY OBJECTIVE: The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital.
    METHODS: All cases were recruited prospectively for 1 year. The hospitals were purposefully selected as typical for Malaysia. There are 3 primary outcome measures: death, musculoskeletal impairment, and disability at discharge. Adjustment was made for potential covariates and within-hospital clustering by using multivariable random-effects logistic regression analysis.
    RESULTS: For direct admissions, logistic-regression-identified odds of dying were associated with older age (>55 years), odds ratio (OR) 1.9 (95% confidence interval [CI] 1.3 to 2.8); head injury, OR 2.7 (95% CI 1.9 to 3.9); arrival by means other than ambulance, OR 0.6 (95% CI 0.4 to 0.8); severe injuries (Injury Severity Score >15) at a district general hospital, OR 45.2 (95% CI 27.0 to 75.7); severe injuries at a tertiary care hospital, OR 11.2 (95% CI 7.3 to 17.3); and admission to a tertiary care hospital compared to a district general hospital if severely injured (Injury Severity Score >15), OR 0.2 (95% CI 0.1 to 0.4). Admission to a tertiary care hospital was associated with increased odds of disability (OR 1.9; 95% CI 1.5 to 2.3) and musculoskeletal impairment (OR 3.5; 95% CI 2.7 to 4.4) at discharge.
    CONCLUSION: Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.
    Matched MeSH terms: Hospitals, District/standards*; Hospitals, General/standards*
  20. Fulltext The Australian Aged Care and Its Implications for the Korean Aging Crisis
    Kim MY, Subramaniam P, Flicker L
    Ann Geriatr Med Res, 2018 Mar;22(1):9-19.
    PMID: 32743238 DOI: 10.4235/agmr.2018.22.1.9
    The Australian aged care system has evolved for >50 years to support frail older adults and allow them to make informed decisions about their care. Hospitals provide streamlined geriatric services from visits at the Emergency Department to discharges from acute and subacute geriatric care units. Moreover, nonhospital aged care services, including Transition Care Program, Commonwealth Home Support Program, Home Care Packages Program, and Residential Care (nursing home) are provided under the auspices of the Australian Government. These various specialized hospital and nonhospital services are integrated and coordinated by the multidisciplinary assessment team called ACAT (Aged Care Assessment Team). Korea does not have a similar amount of time to prepare a well-organized aged care system because of a rapidly increasing older population. The Korean government and aged care experts should exert vigorous efforts to improve the last journeys of the Korean older population.
    Matched MeSH terms: Hospitals
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