Displaying publications 61 - 80 of 111 in total

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  1. Fulltext A 3 year audit of infected pseudoaneurysms in intravenous drug users managed surgically in the Vascular Unit, Hospital Kuala Lumpur
    Zainal AA, Yusha AW
    Med J Malaysia, 1998 Dec;53(4):372-5.
    PMID: 10971980
    This is a study of 54 intravenous drug user's (IVDUs) with infected pseudoaneurysms undergoing ligation and debridement at the Vascular Unit, Hospital Kuala Lumpur (HKL) from February 1993 to February 1996. The median age was 37 years with a male preponderance (53:1). Chinese form the largest ethnic group with 57.4% of the cases. Staphylococcus aureus was the most common organism cultured. Human immunodeficiency virus (HIV) positive cases numbered 21 (38.9%). Four of the patients had to have an above-knee amputation after surgery. Simple ligation and debridement of all necrotic tissue is an acceptable mode of therapy in these patients with low amputation rates.
    Matched MeSH terms: Medical Audit*
  2. Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance
    Lim TO, Soraya A, Ding LM, Morad Z
    Int J Qual Health Care, 2002 Jun;14(3):251-8.
    PMID: 12108535
    Quality assurance of medical practice requires assessment of doctors' performance, whether informally via a system such as peer review or more formally via one such as credentialing. Current methods of assessment are, however, subjective or implicit. More objective methods of assessment based on statistical process control technique such as cumulative sum (CUSUM) procedure may be helpful.
    Matched MeSH terms: Medical Audit/methods*
  3. Fulltext A clinical audit on diabetes care in two urban public primary care clinics in Malaysia
    Sazlina SG, Zailinawati AH, Zaiton A, Ong I
    Malaysian Journal of Medicine and Health Sciences, 2010;6(1):101-109.
    MyJurnal
    Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year. Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5 %. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6 mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was
    found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour.
    Matched MeSH terms: Medical Audit*
  4. Fulltext Morbidity associated with asthma and audit of asthma treatment in out-patient clinics
    Lim TO, Suppiah A, Ismail F, Selvan T, Khan NKI, Ngah BA
    Singapore Med J, 1992 Apr;33(2):174-6.
    PMID: 1621123
    A study was undertaken to determine the extent of morbidity associated with asthma and to audit the management of asthma in two out-patient clinics of two district hospitals. Patients were recruited for the study during a 3-month period from December 1990 to February 1991. Seventy asthmatic patients were studied. Eighty-six percent of the patients had their sleep disturbed by asthma, 77% took daily medication regularly, 63% felt that their activities were restricted by asthma, 60% had at least one acute exacerbation in the preceding six months. Of those who had their peak expiratory flow rate (PEFR) measured, 40% had a PEFR below 50% predicted, and only 11% had normal PEFR (greater than 80% predicted). The morbidity of asthma was thus considerable. On the other hand, the drug treatment of these asthmatics was grossly inadequate. They were prescribed on average 2.1 item of drugs, which for most patients comprised an oral beta agonist and a theophylline. Only 43% of the patients received inhaler therapy, but no patients were given steroids, inhaled or oral. The drug treatment was unrelated to the severity of patients' asthma. Further, objective measurement of severity was under-used in the assessment of asthma, only 8.5% of patients ever had their PEFR recorded. This study has found that asthma is poorly managed in out-patient clinics. We need to improve the training of doctors in the optimal management of asthma.
    Study site: General outpatient clinics, district hospitals, Pahang, Malaysia
    Matched MeSH terms: Medical Audit*
  5. Fulltext Comparative audit of abdominal aortic aneurysm repairs using POSSUM scores
    Yii MK
    Asian J Surg, 2003 Jul;26(3):149-53.
    PMID: 12925289 DOI: 10.1016/S1015-9584(09)60374-2
    Abdominal aortic aneurysm (AAA) repairs represent a significant workload in vascular surgery in Asia. This study aimed to audit AAA surgery and evaluate the application of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) in an Asian vascular unit for standard of care. Eighty-five consecutive surgical patients with AAA from a prospective vascular database from July 1996 to December 2001 in Sarawak were available for analysis. Comparisons between predicted deaths by P-POSSUM and observed deaths in both urgency of surgery categories (elective, urgent, emergency ruptures) and risk range groups (0-5%, >5-15%, >15-50%, >50-100%) were made. No significant difference was found between the predicted and observed rates of death for elective, urgent and emergency AAA repairs. The observed mortality rates were 5%, 18% and 30%, respectively. The observed rates of death were also comparable to P-POSSUM predicted rates of death in the various risk range groups. The POSSUM score used with the P-POSSUM mortality equation is easy to use and applicable as a comparative vascular auditing tool in Asia.
    Matched MeSH terms: Medical Audit*
  6. Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital
    Leong CL, Buising K, Richards M, Robertson M, Street A
    Intern Med J, 2006 Jan;36(1):37-42.
    PMID: 16409311
    BACKGROUND: Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index.
    AIM: To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors.
    METHODS: This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg.
    RESULTS: A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines.
    CONCLUSION: Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.
    Matched MeSH terms: Medical Audit*
  7. Fulltext General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting
    Teng CL, Achike FI, Phua KL, Norhayati Y, Nurjahan MI, Nor AH, et al.
    Int J Antimicrob Agents, 2004 Nov;24(5):496-501.
    PMID: 15519484 DOI: 10.1016/j.ijantimicag.2004.06.015
    Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.
    Study site: Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Medical Audit/statistics & numerical data
  8. Fulltext Audit on cardiovascular disease preventive care in general practice
    Chan SC, Lee TW, Teoh LC, Abdullah ZC, Xavier G, Sim CK, et al.
    Singapore Med J, 2008 Apr;49(4):311-5.
    PMID: 18418523
    INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit.
    METHODS: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards.
    RESULTS: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics.
    CONCLUSIONS: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.
    Matched MeSH terms: Medical Audit*
  9. Fulltext Endoscopic-assisted craniofacial resection: a case series and post-operative outcome
    Gendeh BS, Salina H, Selladurai B, Jegan T
    Med J Malaysia, 2007 Aug;62(3):234-7.
    PMID: 18246914 MyJurnal
    Craniofacial resection is commonly performed in the surgical resection of sinonasal tumours involving anterior skull base. It entails a bicoronal scalp flap with lateral rhinotomy or an extended lateral rhinotomy to expose the anterior skull base. Transfacial approach is necessary in the resection of the nasal part of the tumour. The choice of surgical approach is based heavily on the surgeon's experience and training. The results of endoscopic-assisted craniofacial resection for sinonasal tumours performed in our center in eight patients from 1998 to 2005 were reviewed. There were seven males and one female with age ranging from 18 to 62 years (mean 42.4 years). There was each a case of mature teratoma, poorly differentiated squamous cell carcinoma, undifferentiated squamous cell carcinoma, olfactory neuroblastoma, fibrous dysplasia, inverted papilloma and two cases of sinonasal neuroendocrine carcinoma. The mean follow up duration for these eight patients post surgery was 21.4 months. Out of eight patients, five underwent surgery with no adverse complications. The complications encountered were a cerebrospinal leak and a postoperative transient V and VI cranial nerve palsy. One patient with sinonasal undifferentiated carcinoma died of lung metastasis at 11 months post-surgery. The endoscopic-assisted craniofacial resection is a highly useful surgical technique to avoid the unsightly facial scar of the lateral rhinotomy or the Weber-Ferguson incision, postoperative paranasal sinuses infection and avoidance of tracheostomy in selected cases. We found that this approach has lower morbidity rate in selected cases.
    Matched MeSH terms: Medical Audit
  10. Fulltext Outcome of patients presenting with preauricular sinus in a tertiary centre--a five year experience
    Tang IP, Shashinder S, Kuljit S, Gopala KG
    Med J Malaysia, 2007 Mar;62(1):53-5.
    PMID: 17682572
    We reviewed the recurrence rate and possible factors influencing recurrence of preauricular sinus after excision. Seventy-one patients with 73 preauricular sinuses seen at our centre from year 2000 to 2005 were reviewed in this study. The overall recurrence rate was 14.1%. Twelve sinuses needed to be drained for an abscess prior to a definitive surgery. Different modalities used in demonstrating the sinus tract between methylene blue alone and probing together with methylene blue, showed different outcomes, which were statistically significant with a p value of < 0.05(chi-square test). A preauricular sinus with a previous history of infection or actively infected during the definitive surgery may have a higher tendency of recurrence. Meanwhile demonstrating the sinus tract by probing with lacrimal probe/sinus probe followed by injection of methylene blue reduces the recurrence rate (p < 0.05 with chi-square test).
    Matched MeSH terms: Medical Audit
  11. Fulltext Prescribing patterns and drug cost among cardiovascular patients in Hospital Universiti Kebangsaan Malaysia
    Al-Junid SM, Ezat WP, Surianti S
    Med J Malaysia, 2007 Mar;62(1):59-65.
    PMID: 17682574 MyJurnal
    A prevalence study was conducted, measuring drug cost and prescribing patterns of clinicians treating cardiovascular patients in UKM Hospital (HUKM). One Hundred and thirty-five patients' case-notes were selected from the Case-Mix database of HUKM. The average and median number of drugs prescribed per patient was 7.56 (+/- 3.37) and 7.0 (+/- 3) respectively. Generic drug prescription rate was still low (45.2%). Significant relationship was observed between generic drug prescriptions with age of patients, types of wards and different levels of clinicians' training. Younger patients, admitted to Coronary Care Unit (CCU) and Cardiology Rehabilitation Ward (CRW) were more likely to be prescribed with branded drugs. Lower generic drugs prescription and higher cost of drugs were mostly practised by Consultants. CCU and CRW wards were the only predictor to having low generic drugs prescriptions. Ninety-nine percent of the total RM28,879.25 drug cost was used to purchase branded drugs. Mean drug cost for a patient is RM213.92 (+/- RM333.36) and median cost is RM102.46 (+/- RM240.51). Higher drug cost and its' predictors were patients with severity level II and III, length of stay of > or = 6 days, number of drugs types of > or = 7, generic drugs prescription rate < 50% and patients admitted in CCU and CRW wards. This study is important for short and long-term decision-making, controlling of providers behaviour and resources.
    Matched MeSH terms: Medical Audit
  12. Fulltext Survivin expression correlates with unfavourable prognoses in invasive ductal carcinoma of the breast
    Al-Joudi FS, Iskandar ZA, Imran AK
    Med J Malaysia, 2007 Mar;62(1):6-8.
    PMID: 17682561 MyJurnal
    Survivin is a 16.5-kDa intracellular protein also known as AP14 or BIRC5. It inhibits apoptosis and regulates cell division and belongs to the inhibitors of apoptosis (IAP) gene family. In the majority of neoplasms investigated for survivin expression, high levels of the IAP proteins were predictive of tumour progression, either in terms of disease-free survival or overall survival, thus providing significant prognostic information. Hence, the prognostic value of survivin expression in tumour masses of invasive ductal carcinoma has been investigated. It was found that negative and low expression of survivin correlated significantly with favourable outcomes. Conversely, high expression correlated with unfavourable outcomes. The five-year survival rate was higher among the cases with low and negative survivin expression, compared to those with higher survivin expression. However, this correlation was found to be insignificant statistically. Furthermore, a statistical model has been devised to explain the combined effects of survivin expression and its sub-cellular localisation, p-53 expression and lymph nodal involvement, on the outcomes of these patients.
    Matched MeSH terms: Medical Audit
  13. Fulltext Use of intramuscular botulinum toxin in Malaysian children with cerebral palsy
    Khoo TB, Yusniza MY, Chern PM
    Med J Malaysia, 2007 Mar;62(1):3-5.
    PMID: 17682560 MyJurnal
    A study was carried out to determine the clinical effectiveness of intramuscular botulinum toxin type A (BTX) in the treatment of spasticity or dystonia in 58 consecutive children with cerebral palsy (CP). The effectiveness of the treatment was determined by the reduction of spasticity and global parental perception scale. The mean age of treatment was six years and the most frequent aim of treatment (91.1%) was functional improvement. The median reduction of spasticity as measured by modified Ashworth scale was 1. The short term outcome was graded as excellent or good by 44.6% and satisfactory by 38.4% of parents. Patients with dyskinetic Cerebral Palsy had the best response. Adverse effects were minimal. BTX treatment is modestly effective in the majority of our patients with spastic and dyskinetic cerebral palsy.
    Matched MeSH terms: Medical Audit
  14. Audit of Web-based telemedicine in ophthalmology
    Kennedy C, Bowman R, Fariza N, Ackuaku E, Ntim-Amponsah C, Murdoch I
    J Telemed Telecare, 2006;12(2):88-91.
    PMID: 16539756
    A Web-based service was set up to link subspecialist ophthalmologists with those seeking advice on particular clinical problems in ophthalmology. The service operated between countries, with centres in Malaysia, Ghana, Tanzania, South Africa and Gambia seeking advice from Moorfields Eye Hospital in the UK. It also operated within country, where a rural clinic in The Gambia sought advice from the central hospital on difficult cases or cases for possible referral. Provision of Web access and training in image capture and manipulation were undertaken in each participating centre. During the first 12 months, 132 cases were posted to the Website from five of the six centres participating. The rate of case referral rose to about 12-14 cases per month by the end of the study. Overall, 24% of referrals did not use images. In the first four months the response time was 13 days, and in the last four months it was three days. Most cases were answered with a single response from the specialist. The main problem was the amount of Internet down-time in each of the locations. The main benefit was safe and reliable access to specialist advice for practitioners.
    Matched MeSH terms: Medical Audit
  15. Hypospadias repair: Byar's two stage operation revisited
    Arshad AR
    Br J Plast Surg, 2005 Jun;58(4):481-6.
    PMID: 15897031
    Hypospadias is a congenital deformity characterised by an abnormally located urethral opening, that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum. Many operations had been described for the management of this deformity.
    Matched MeSH terms: Medical Audit
  16. A study of the appropriateness of antibiotic use in the medical wards of a tertiary teaching hospital in Malaysia
    Hooi PY, Yong CM, Cheong I
    Int J Clin Pract, 2001 May;55(4):272-4.
    PMID: 11406914
    A prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four-week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22-65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.
    Matched MeSH terms: Medical Audit
  17. Fulltext Demographic characteristics and prevalence of other sexually transmitted diseases in HIV-positive patients seen in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah, Johor Bahru
    Choon SE, Mathew M, Othman BS
    Med J Malaysia, 2000 Jun;55(2):174-9.
    PMID: 19839145
    The demographic characteristics, risk behaviourand prevalence of other sexually transmitted diseases (STDs) were determined in 132 HIV-infected individuals seen in a Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru. Sixty-one (46.2%) were Malays, 37.9% Chinese, 10.6% Indians and 5.3% were of other ethnic groups. The male to female ratio was 4.5:1. Most of the patients (82.5%) were between 20 to 40 years-old. Seventy (53.0%) were single, 34.1% were married and 7.5% were divorcees. The majority of them (97.7%) were heterosexual. Fifty seven (53.3%) of our male patients patronised commercial workers. Eighty-one (61.8%) were not intravenous drug users (IVDU). Of the 50 IVDUs, 24 had multiple sexual exposures. Fifty-three (48.2%) of the 109 patients screened for STDs had one or more other STDs. Thirty-four patients (31.9%) reported one STD in the past and 3.6% reported two STDs in the past. Fifty-six patients (42.4%) had developed AIDS. Thirteen had passed away. The main mode of transmission of HIV infection in this population is through heterosexual intercourse and the prevalence of STDs is high. These findings indicate a need to advocate responsible sexual behaviour and to detect as well as treat STDs early to prevent the sexual transmission of HIV.

    Study site: Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru
    Matched MeSH terms: Medical Audit
  18. Appropriateness of colonoscopy in a tertiary referral centre
    Jabar MF, Halim ME, Gul YA
    Asian J Surg, 2004 Jan;27(1):26-31.
    PMID: 14719511
    The aim of this study was to determine the appropriateness of colonoscopy in relation to its diagnostic yield, with reference to the guidelines set by the American Society of Gastrointestinal Endoscopy (ASGE). A prospective 90-day audit was performed at Hospital Kualal Lumpur, which is a tertiary referral centre in Malaysia, to examine the appropriateness of colonoscopy by indication. During that time, 257 colonoscopies were performed in 244 patients. The predominant indications for colonoscopy were altered bowl habit (37%) and rectal bleeding (18%). Of the 257 colonoscopies, 216 (84%) were judged to be appropriate by ASGE guidelines. Only 43% of all colonoscopies had positive findings. Positive findings were found in 93% of cases judged appropriate compared with only 7% found in cases deemed inappropriate. There were statistically significant relationships between appropriateness and overall positive yield and between appropriateness and neoplastic findings (p < 0.05). Colonoscopy performed for appropriate indications yield more significant findings, this, we advocate the use of accepted guidelines to maintain or improve the standard colonoscopy services.
    Matched MeSH terms: Medical Audit
  19. Fulltext Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity
    Yii MK, Ng KJ
    Br J Surg, 2002 Jan;89(1):110-3.
    PMID: 11851674
    BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is an objective and appropriate scoring system for risk-adjusted comparative general surgical audit. This score was devised in the UK and has been used widely, but application of POSSUM to centres outside the UK has been limited, especially in developing countries. This prospective study validated its application in a surgical practice with a different population and level of resources.
    METHODS: All general surgical patients who were operated on under regional or general anaesthesia as inpatients over a 4-month period at Sarawak General Hospital in 1999 were entered into the study. All data (12 physiological and six operative factors) were analysed for mortality only with the POSSUM equation and the modified Portsmouth POSSUM (P-POSSUM) equation. Comparisons were made between predicted and observed mortality rates according to four groups of risk: 0-4, 5-14, 15-49 and 50 per cent or more using the 'linear' method of analysis.
    RESULTS: There were 605 patients who satisfied the criteria for the study. Some 56.7 per cent of patients were in the lowest risk group. The POSSUM predictor equation significantly overestimated the mortality in this group, by a factor of 9.3. The overall observed mortality rate was 6.1 per cent and, again, the POSSUM predictor equation overestimated it at 10.5 per cent (P < 0.01). In contrast, the observed and predicted mortality rates for all risk groups, including the predicted overall mortality rate of 4.8 per cent, were comparable when the P-POSSUM predictor equation was used.
    CONCLUSION: The POSSUM scoring system with the modified P-POSSUM predictor equation for mortality was applicable in Malaysia, a developing country, for risk-adjusted surgical audit. This scoring system may serve as a useful comparative audit tool for surgical practice in many geographical locations.
    Matched MeSH terms: Medical Audit
  20. Diagnostic yield of medical thoracoscopy in exudative pleural effusions in a region with high tuberculosis burden
    Kho SS, Chan SK, Yong MC, Tie ST
    Med J Malaysia, 2020 05;75(3):254-259.
    PMID: 32467541
    INTRODUCTION: Pleural effusion is frequently encountered in respiratory medicine. However, despite thorough assessment including closed pleural biopsy, the cause of around 20% of pleural effusions remains undetermined. Medical thoracoscopy (MT) is the investigation of choice in these circumstances especially if malignancy is suspected. The aim of this study is to evaluate the diagnostic yield of MT in exudative pleural effusions in a single center from East Malaysia.

    METHODS: Retrospective chart review of all adult patients who underwent MT for undiagnosed exudative pleural effusion in a 24-month duration.

    RESULTS: Our cohort comprised of 209 patients with a median age of 61 years old (IQR 48.5-69.5). There were 92 (44%) patients with malignant pleural effusion (MPE) and 117 (56%) benign effusions; which included 85 tuberculous pleural effusion (TBE) and 32 cases of non-tuberculous exudative pleural effusion. Conclusive pathological diagnosis was made in 79.4% of the cases. For diagnosis of MPE, MT had a sensitivity of 89.1% (95% CI 80.4-94.3), specificity of 100% (95% CI 96.0-100.0), and positive predictive value (PPV) of 100% (95% CI 94.4-100) and negative predictive value (NPV) of 92.1% (95% CI 85.6-95.9). For TBE, MT had a sensitivity of 90.5% (95% CI 81.8-95.6), specificity of 100% (95% CI 96.3- 100.0) PPV of 100% (95% CI 94.1-100) and NPV of 93.9% (95% CI 88.0-97.2). Overall complication rate was 3.3%.

    CONCLUSIONS: MT showed excellent sensitivity and specificity in the diagnosis of exudative pleural effusion in this region. It reduces empirical therapy by providing histological evidence of disease when initial non-invasive investigations were inconclusive.

    Matched MeSH terms: Medical Audit
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