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Fulltext Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia

Atif M, Sulaiman SA, Shafie AA, Asif M, Babar ZU

BMC Health Serv Res, 2014 Aug 19;14:353.
PMID: 25138659 DOI: 10.1186/1472-6963-14-353

BACKGROUND: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.
METHODS: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).
RESULTS: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.
CONCLUSION: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext Fentanyl pre-treatment alleviates pain during injection of propofol-lipuro premixed with lignocaine

Ahmad N, Zanariah Y, Balan S

Med J Malaysia, 2008 Dec;63(5):431-3.
PMID: 19803312

We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.

Matched MeSH terms: Hospitals, General
Fulltext Percutaneous dilational tracheostomy--a 3 year experience in a general hospital in Malaysia

Tan CC, Lee HS, Balan S

Med J Malaysia, 2004 Dec;59(5):591-7.
PMID: 15889560

All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.

Matched MeSH terms: Hospitals, General
Fulltext Blunt injuries to the liver: problems and management

Balasegaram M

Ann Surg, 1969 Apr;169(4):544-50.
PMID: 5774743

Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.

Matched MeSH terms: Hospitals, General
Emotional expressiveness and the quality of life of patients with schizophrenia

Mubarak AR, Barber JG

Soc Psychiatry Psychiatr Epidemiol, 2003 Jul;38(7):380-4.
PMID: 12861444 DOI: 10.1007/s00127-003-0645-0

Background: The present research aims to study the association between emotional expressiveness of primary care-givers and quality of life of patients with schizophrenia.
Method: The data for the present study were collected from 174 purposively selected patients with schizophrenia and their primary care-givers. The Quality of Life Interview (QOLI) (Lehman 1988) was used to collect information related to the quality of life of patients. The care-givers‘ emotional expressiveness was assessed using three questions on home environment from Disability Assessment Schedule (WHO/DAS) (WHO 1988).
Results: Three components of emotional expressiveness were included in the present research, namely, emotional involvement, control and attitude of rejection. Among these three components, emotional involvement of key care-givers was found to have a significant association with quality of life of schizophrenia patients.
Conclusion: Based on this result, the present study argues that emotional involvement of key care-givers needs careful attention while planning psychosocial rehabilitation programmes aimed at enhancing the quality of life of schizophrenia patients.
Keywords: emotional expression – quality of life – schizophrenia – emotional involvement – community – Asia

Matched MeSH terms: Hospitals, General
Sarawak: our elective

Maxwell P, Barker R

J R Soc Med, 1989 Aug;82(8):496-7.
PMID: 2778782
Matched MeSH terms: Hospitals, General
Fulltext Vascular trauma in Penang and Kuala Lumpur Hospitals

Lakhwani MN, Gooi BH, Barras CDJ

Med J Malaysia, 2002 Dec;57(4):426-32.
PMID: 12733167

OBJECTIVES: The nature of vascular trauma varies greatly between continents and across time. The aim of this study was to prospectively analyse the demographics, pathology, management and clinical outcomes of vascular injuries in two urban Malaysian hospitals and review of international literature on vascular trauma. From this information, preliminary management and preventive implications will be described.
METHODS: Eighty-four consecutive cases of trauma requiring vascular surgery were prospectively analysed over three years at Hospital Kuala Lumpur and Hospital Pulau Pinang, Malaysia. Extensive patient demographic and injury data, including the mechanism of injury, associated injuries, angiographic findings, operative details and post-operative complications, were systematically gathered.
RESULTS: Most vascular injuries were incurred by males (76/84), with 37% (28/76) of them aged between 21 and 30 years. Malays were most frequently injured (n = 36) followed by Chinese and Indians. Road traffic accidents (n = 49) substantially outnumbered all other causes of injury. Lower limb injuries (n = 57) occurred more than twice as often as upper limb injuries (n = 27). Complete arterial transections (n = 43) and intimal injuries (n = 27) were more common than arterial lacerations (n = 10) and pseudoaneurysms (n = 4). The most frequently damaged vessels were the popliteal/tibioperoneal trunk (n = 33). All patients received urgent Doppler ultrasound assessment and, where possible, ankle-brachial systolic index measurement. Of all patients, 40 received an angiogram, haemodynamic instability making this investigation impractical in others. Primary arterial repair was the most frequently employed surgical procedure (n = 54) followed by autogenous reverse long saphenous vein (LSV) interposition graft (n = 14), embolectomy (n = 5) and PTFE interposition graft (n = 3). The most common post-operative complication was wound infection (n = 11). Amputation, as a last resort, was required in 13 cases following either primary or autogenous reverse LSV repair complicated by sepsis or critical ischaemia.
CONCLUSIONS: Vascular trauma, especially in conjunction with severe soft tissue, nerve or orthopaedic injury carries colossal physical, psychological, financial and social costs. Associated nerve and venous injury portended poor outcome in this study. Whilst orthopaedic trauma was a common association, the concurrence of occult vascular trauma and soft tissue injury without fracture emphasises the crucial importance of thorough and rapid clinical vascular assessment, investigation and surgical intervention. Fasciotomy, especially for the lower limb, is important for the prevention of compartment syndrome and its, limb-threatening sequelae. Primary preventive road safety promotion and interventions, with attention to high-risk groups (young males and motorcyclists), is urgently required.

Matched MeSH terms: Hospitals, General
Fulltext Locus of control and reaction to illness: a study of patients with chronic renal failure

Boey KW

Med J Malaysia, 1984 Dec;39(4):275-9.
PMID: 6544932

The relationship between locus of control and reaction to illness is empirically examined in a group of patients on haemodialysis for chronic renal failure. Results of the study suggest that patients who perceive themselves as having personal control over life events tend to have stronger feelings that their illness has made them dependent on others. There is also a greater tendency for them to exhibit more information seeking behaviour, and to adopt an active, problem-solving and intellectual approach to cope with their chronic renal failure. Relevance of the findings and implication for treatment outcome are discussed.

Matched MeSH terms: Hospitals, General
Family-centred hospital treatment in the aboriginal people of West Malaysia

Bolton JM

Community Health (Bristol), 1973 Sep-Oct;5(2):70-4.
PMID: 4787593
Matched MeSH terms: Hospitals, General*
Fulltext Morbidity and mortality of infants of diabetic mothers born at the Maternity Hospital, Kuala Lumpur

Boo NY

Med J Malaysia, 1992 Mar;47(1):56-9.
PMID: 1387451

A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.

Matched MeSH terms: Hospitals, General
Quality control in dual head gamma-cameras: Comparison between methods and software used for image analysis

Edam AN, Fornasier MR, De Denaro M, Sulieman A, Alkhorayef M, Bradley DA

Appl Radiat Isot, 2018 Nov;141:288-291.
PMID: 30122471 DOI: 10.1016/j.apradiso.2018.07.027

Patient radiation dose and image quality are primary issues in the conduct of nuclear medicine (NM) procedures. A range of protocols are currently used in image acquisition and analysis of quality control (QC) tests, with National Electrical Manufacturers Association (NEMA) methods and protocols widely accepted in providing an accurate description, measurement and report of γ-camera performance parameters. However, no standard software is available for image analysis. Present study compares vendor QC software analysis and three types of software freely downloadable from the internet: NMQC, NM Toolkit and ImageJ-NM Toolkit software. These were used for image analysis of QC tests of γ-cameras based on NEMA protocols including non-uniformity evaluation. Ten non-uniformity QC images were obtained using a dual head γ-camera installed in Trieste General Hospital and then analyzed. Excel analysis was used as the baseline calculation for the non-uniformity test according to NEMA procedures. The results of non-uniformity analysis showed good agreement between the independent types of software and Excel calculations (the average differences were 0.3%, 2.9%, 1.3% and 1.6% for the Useful Field of View (UFOV) integral, UFOV differential, Central Field of View (CFOV) integral and CFOV differential, respectively), while significant differences were detected following analysis using the company QC software when compared with Excel analysis (the average differences were 14.6%, 20.7%, 25.7% and 31.9% for the UFOV integral, UFOV differential, CFOV integral and CFOV differential, respectively). Compared to use of Excel calculations use of NMQC software was found to be in close accord. Variation in results obtained using the three types of software and γ-camera QC software was due to the use of different pixel sizes. It is important to conduct independent analyses tests in addition to using the vendor QC software in order to determine the differences between values.

Matched MeSH terms: Hospitals, General
Fulltext Tolerance of daily single compared to space dose of Merital

Haq SM, Buhrich N

Med J Malaysia, 1980 Jun;34(4):358-62.
PMID: 7219263

Merital is a recently introduced antidepressant agent which is structurally unrelated to the traditional antidepressant agents and which is reported to have minimal side effects. This study aimed to establish the olerance of a single compared to a spaced dose .schedule of Merital. It was found that a single morrung dose of Merital 100 mgs compared to a similar dose of the drug given in two divided doses did not appreciably increase the frequency or severity of side effects.

Matched MeSH terms: Hospitals, General
Fulltext Mumps encephalomyelitis

Tan KK, Manickam WD, Cardosa MJ

Singapore Med J, 1992 Oct;33(5):525-6.
PMID: 1455285

A 7-year-old Indian girl developed complete paralysis of her lower limbs and acute urinary retention 10 days after suffering from mumps. Encephalomyelitis due to mumps was not suspected initially since it is a rare complication of mumps, although relatively well-documented. However, the preceding history of parotitis and the presence of mumps-specific IgM in both blood and cerebrospinal fluid led to the diagnosis. The initially severe acute neurological deficits resolved completely three months after onset of her illness. Serological investigations were helpful in diagnosing neurological complications of mumps in this case, and especially where there is no preceding parotitis.
Keywords: Mumps, encephalomyelitis, infection, Pulau Pinang, general hospital, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext BCG adenitis - Need for increased awareness

Govindarajan KK, Chai FY

Malays J Med Sci, 2011 Apr;18(2):66-9.
PMID: 22135589

Bacille Calmette-Guerin (BCG) vaccination for protection against tuberculosis has been in use for long. Although the vaccine is safe, its administration can result in complications such as BCG adenitis. We report here a series of children with BCG adenitis with a view to recognise and manage this condition. It is hoped that this case series would encourage the increased identification of this condition.
Study site: Paediatric Surgical Unit, Department of Surgery, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia

Matched MeSH terms: Hospitals, General
A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia

Loo CH, Tan WC, Khor YH, Chan LC

Med J Malaysia, 2018 04;73(2):73-77.
PMID: 29703869 MyJurnal

INTRODUCTION: Severe cutaneous adverse drug reactions (SCARs) are not uncommon and potentially lifethreatening. Our objective is to study the patient characteristics, the pattern of implicated drugs and treatment outcome among patients with SCARs.
METHODS: A 10-year retrospective analysis of SCARs cases in Penang General Hospital was carried out from January 2006 to December 2015. Data collection is based on the Malaysian Adverse Drug Reactions Advisory Committee registry and dermatology clinic records.
RESULTS: A total of 189 cases of SCARs were encountered (F:M ratio; 1.2:1.0; mean age of 45 year). The commonest manifestation was Stevens-Johnson Syndrome [SJS] (55.0%), followed by toxic epidermal necrolysis [TEN] (23.8%), drug rash with eosinophilia and systemic symptoms [DRESS] (12.7%), acute generalised exanthematous pustulosis [AGEP] (4.8%), SJS/TEN overlap syndrome (2.6%) and generalised bullous fixed drug eruptions [GBFDE] (1.1%). Mean time to onset for TEN/SJS/Overlap syndrome was 10.5±13 days; AGEP, three days; GBFDE, 2.5±0.7 days, and DRESS, 29.4±5.7 days. The most common drugs implicated were antibiotics (33.3%), followed by allopurinol (18.9%) and anticonvulsant (18.4%). Out of 154 cases of SJS/TEN/overlap syndrome, allopurinol was the commonest causative agents (20.1%). In DRESS, allopurinol accounts for 45.8% of the cases. The mortality rate in SJS, TEN and DRESS were 1.9%, 13.3% and 12.5% respectively. No mortality was observed in AGEP and GBFDE.
CONCLUSION: The commonest manifestations of SCARs in our setting were SJS, TEN and DRESS. Allopurinol was the most common culprit. Thus, judicious allopurinol use is advocated and pre-emptive genetic screening for HLAB *5801 should be considered.

Matched MeSH terms: Hospitals, General
Fulltext Annual and geographical distribution of Shigella serotypes in Sabah, Malaysia from 1974 to 1978

Kan SKP, Chan MKC

Med J Malaysia, 1980 Sep;35(1):9-13.
PMID: 7254007

19,983 cases of diarrhoea throughout Sabah, Malaysia from January 1971 to December 1978 were bacteriologically examined for Shigella. A total of 241 Shigella isolates representing 9 serotypes were encountered. S. flexneri and S. sonnei accounted for 69.7% and 29.5% of the isolates respectively. S. flexneri type 2 was very common and comprised 47% of the flexneri strains. S. flexneri types 5.6 and Y were rarely found. Only two cases of S. boydii were isolated. S. dysenteriae was not encountered. Isolation rates ranged from 0.64% to 1.73% while the percentages or cases of diarrhoea bacteriologically examined in relation to the number notified range from 13.7 to 29.6. Kota Kinabalu. Tawau and Sandakan accounted for 50.6%. 21.2% and 8.2% of Shigella isolates respectively. However. no isolations were made from Lahad Datu, Semporna and Victoria [Labuan Island]. S. flexneri type 5 was only found in Sandakan while S. flexnert type Y was isolated from Kota Kinubulu. No S. Sonnel was found in Ranau and Tenom.

Matched MeSH terms: Hospitals, General
Fulltext Appropriateness of medical admissions from a Malaysian public primary care clinic

Chan SC

Med J Malaysia, 1999 Sep;54(3):329-37.
PMID: 11045059

Appropriateness of medical admissions from a Malaysian public primary care clinic (Outpatient Department, Hospital Ipoh) was assessed by two physicians using a modified appropriateness evaluation protocol. Of 122 admissions between 16/6/96 and 15/7/96, 107 records (88%) could be traced from the records office. Eighty percent (86/107) were found to be appropriate and 20% (21/107) inappropriate admissions. Inappropriate admissions included admissions to the wrong discipline and patients who could be investigated and stabilised as outpatients or could be referred to specialist clinics. Protocols, provisions for urgent referrals and medical updates for doctors are recommended.

Study site: Outpatient Department, Hospital Ipoh

Matched MeSH terms: Hospitals, General
Fulltext Practice of breast self-examination amongst women attending a Malaysian Well Person's Clinic

Chan SC

Med J Malaysia, 1999 Dec;54(4):433-7.
PMID: 11072459

The practice of breast self-examination (BSE) amongst 1,303 women registered with the Well Person's Clinic, Outpatient Department, Hospital Ipoh between April 1995 and March 1997 were assessed through a questionnaire. Majority (98.2%) were never taught and did not practise BSE, 17(1.3%) practised BSE while 6 (0.5%) were taught BSE but failed to put it into practice. Only 5.8% of 52 women with past/family history of breast cancer/lump and 2.9% of 207 women with past/family history of other cancers were practising BSE regularly. Three out of 64 women with breast lumps found on clinical breast examination discovered the lumps themselves. Five of the 64 women were subsequently confirmed to have breast carcinoma.
Study site: Outpatient clinic, Hospital Ipoh, Perak, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext A Malaysian Well Person's Clinic--review of patients seen between April and December 1995

Chan SC

Med J Malaysia, 1997 Mar;52(1):53-9.
PMID: 10968053

The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.

Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital

Matched MeSH terms: Hospitals, General
The demographic and morbidity patterns seen in an outpatient department in a Malaysian General Hospital

Chan SC

Family Physician, 1995;7:3-10.

This study aimed to established baseline data on patients' demographic and morbidity patterns over three months in the Outpatients Department (OPD) Ipoh Hospital. Entry of the first ten thousand patients into a computerised database for analysis showed that the majority were unemployed and from the low income group. There were more Malays and Indians, less Chinese. Respiratory infections accounted for 18.5 % while major chronic diseases (hypertension, diabetes mellitus, asthma) were common. Overall a wide spectrum of illnesses were seen. A career structure for OPD doctors and incorporation of Family Medicine concepts were proposed to improve primary care in OPD.
Study site: Outpatients Department (OPD), Hospital Ipoh, Perak, Malaysia

Matched MeSH terms: Hospitals, General

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