Consent is defined as the “voluntary agreement to or acquiescence in what another person proposes or desires”. In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public’s expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient’s signature on consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation.
INTRODUCTION: This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006.
METHODS: This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire.
RESULTS: Of the 22 880 eligible respondents, 88·2% (20 180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6-5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8-39·4) were provided with it by their employers.
DISCUSSION: Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.
Study name: National Health and Morbidity Survey (NHMS-2006)
Intake and Output (I/O) records in hospitals were often found to be incomplete and illegible. The form used to record I/O is not user-friendly - i.e., they feature miniscule boxes, 'total' lines that do not correspond with shift changes and lack of instructions. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. Moreover, Nursing Sisters objective rounds often saw incompleteness of I/O chart. This study aims to identify the types of mistakes in recording the existing I/O chart. The second aim is to find out whether shift totalling of I/O chart helps in reducing mistakes. We try to determine whether the identified mistakes were repeated in the new I/O Chart. This study was conducted from October till December 2010 in 9 selected wards in Sibu Hospital. Data collection was divided into 3 phases. A pre-implementation audit using a checklist was carried out. The compliance rate of completeness of documentation of I/O Chart was 63%. A one month trial of new I/O chart was being done in the selected 9 wards. Post implementation audit showed a significant improvement of compliance rate (88%). Feedback from health care workers (N=110) showed that, 89% of doctors (n=17) and 60% of nurses (n=93) in the sample prefer to use the new format as more practical and relevant to the changing shift of nurses and doctors' ward round. It is suggested to implement the new format to increase compliance rate of documentation of I/O charting. Briefing should be given to nurses periodically and the new format should be introduced to nursing students in nursing colleges.
Objective To compare long-term functional results of ACL reconstruction with a single bundle (SB) and double bundle (DB). Methods Sixty patients who underwent ACL reconstructions from January 2007 to December 2008 were retrospectively evaluated (30 SB and 30 DB ACL reconstructions). Clinical and functional outcomes were measured pre- and postoperatively in terms of anterior drawer test, Lachman's test, pivot shift test, KT1000 side-to-side difference, range of motion, International Knee Documentation Committee Scoring, Lysholm knee scoring scale (LKS), and Tegner activity level scale. The period of follow-up was 10 years. Results Clinical outcome measured showed that anterior drawer test result were equally normal for both groups (93.3%; p > 0.995); however, the Lachman test was 76.7% in the DB group and 56.7% in the SB group (p > 0.100), the pivot shift was 83% in the DB group and 50% in the SB group (p < 0.001), and KT1000 was 76.7% in the DB group and 56.7% in the SB group (p > 0.100). Regarding the functional outcome, it favored the DB group of patients, with the LKS being statistically significant (p < 0.007) and the Tegner activity level scale p-value being <0.001 Conclusions DB ACL reconstruction produces better rotational stability and gives superior functional outcome in terms of return to pre-injury activity level in comparison to SB reconstruction. DB ACL reconstruction using hamstring tendon autograft produces better functional results at 10 years follow-up.