Methods: A cross-sectional study using a validated 20-item questionnaire was conducted among physicians (n=78) and clinical pharmacists (n=45) working in the medical wards of two tertiary hospitals in Malaysia. Knowledge was assessed by six clinical vignettes which were developed based on Beers criteria and the STOPP/START criteria. Other domains of the study were investigated using a four-point or five-point Likert scale.
Results: Of the 82 participants who completed the questionnaire, 65% were physicians, 90.2% had never received training in geriatric medicine, and 70.8% estimated that 25% or more of their patients were elderly. Only six participants (7.3%) had ever used STOPP/START or Beers criteria when prescribing for elderly patients, and 60% of the respondents had never heard of either one of those criteria. The mean score (SD) for the knowledge part was 3.65 (1.46) points, and only 27 participants (22.9%) scored more than four out of a possible six points. Overall, 34% of the participants rated themselves as confident in prescribing for elderly patients, and this was significantly associated with their knowledge score (P=0.02). The mean number (SD) of barriers cited per participant was 6.88 (2.84), with polypharmacy being the most cited barrier.
Conclusions: The majority of the participants had inadequate knowledge and low confidence regarding recommending medications for elderly patients. Continuing education on geriatric pharmacotherapy may be of value for the hospital physicians and pharmacists.
METHODS: MMG and EMG were used to record the activity of the SCM in 32 untrained singers reciting a monotonous text and a standard folk song. Their voices were recorded and their pitch, or fundamental frequency (FF), and intensity were derived using Praat software. Instants of inhale and exhales were identified during singing from their voice recordings and the corresponding SCM MMG and EMG activities were analysed.
RESULTS: The SCM MMG, and EMG signals during breathing while singing were significantly different than breathing at rest (p < 0.001). On the other hand, MMG was relatively better correlated to voice intensity in both reading and singing than EMG. EMG was better, but not significantly, correlated with FF in both reading and singing as compared to MMG.
CONCLUSIONS: This study established MMG and EMG as the quantitative measurement tool to monitor breathing activities during singing. This is useful for applications related to singing therapy performance measure including potentially pathologically effected population. While the MMG and EMG could not distinguish FF and intensity significantly, it is useful to serve as a proxy of inhalation and exhalation levels throughout a particular singing session. Further studies are required to determine its efficacy in a therapeutic setting.
METHODS: The cross-sectional study was conducted in October-November 2017 at five government and two private schools in Bhakkar, Punjab, Pakistan. It comprised children aged 11-12 years. World Health Organisation standards and the modified International Caries Detection and Assessment Systems methods were used were used to determine the dental caries status of each subject. Results of the two methods were compared at all cut- offs where appropriate, using SPSS 17.
RESULTS: Of the 183 subjects, 101(55.2%) were boys. Those aged 12 years were 112(61.2%) while 71(38.8%) were aged 11 years. There was no statistically significant difference in values of the Decayed Missing and Filled Surface / Decayed Missing and Filled Teeth index as well as the prevalence of dental caries between two methods (p>0.05 each). Intra-examiner reproducibility was higher with the World Health Organisation method compared to the other index used (p<0.05).
CONCLUSIONS: Modified International Caries Detection and Assessment Systems method can be used in epidemiological surveys as it was found to provide results similar to the World Health Organisation criteria at cut-off point 2.
PRESENTATION OF CASE: We present a rare case of WS torsion in a 69-year-old elderly patient who presented with an acute abdomen. Physical examination revealed a tender right lower quadrant abdominal mass. Imaging studies confirmed the diagnosis of WS torsion with features of infarction. Subsequently, an emergency laparoscopic splenectomy was performed.
DISCUSSION: A WS occurs due to the hypermobility of the spleen secondary to the absence or laxity of splenic suspensory ligaments. It is more commonly seen in children and adults in the third decade of life. Symptoms are usually attributed to the consequences of splenic vascular pedicle torsion. Exhibited symptoms might be unspecific; thus, radiological modalities are essential to determine the diagnosis and aid in planning its management. The treatment of choice is either open or laparoscopic splenopexy or splenectomy.
CONCLUSION: Due to potentially life-threatening consequences and the rarity of such cases, a thorough history, detailed physical examination, and objective investigation are the pillars to attain a prompt diagnosis for appropriate management to be conducted as soon as possible to minimise complications.
OBJECTIVES: This review focuses on identifying the indicators used to evaluate ACS care pathways and their effect on the care process and clinical outcomes.
METHODS: This review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The systematic research was conducted using five research databases. Two groups were created by dividing the studies according to their year of publication. The first group included those studies published from 1997 to 2007 ("Group 1"), while the second included those published from 2008 to 2018 ("Group 2"). Selected studies were screened using the Effective Public Health Practice Project (EPHPP) quality assessment tool.
RESULTS: Seventeen studies were included in this review. One study was a randomized controlled trial, 14 were predesigns and postdesigns, and two were longitudinal observational designs. The Group 1 studies demonstrated that ACS care pathways had a positive effect on reducing the length of the hospital stay and the door-to-balloon times. Similar effects were observed for the Group 2 studies.
CONCLUSION: Implementing ACS care pathway helps to organize care processes and decrease treatment delays as well as improve the patient outcomes without adverse consequences for patients or additional resources and costs. While the current level of evidence is inadequate to warrant a formal recommendation, there is a need for more studies with an emphasis on well-designed randomization to measure patient outcomes.
METHODS: All the tertiary referrals seen by an FODMAP-trained dietician were reviewed (2013-2016). Patients were evaluated for IBS symptoms by a questionnaire (four-point Likert scale). Subsequently, advice regarding the low FODMAP diet was given. Symptoms' response was assessed at 3-, 6-, and 12-month follow-up, by use of the same questionnaire. Re-introduction of high FODMAP foods was aimed to commence at the subsequent follow-up.
RESULTS: A total of 164 patients were identified. Thirty-seven patients were excluded due to failure to attend for follow-up. Hundred and twenty-seven patients (77% patients, of which 85% were female) completed the initial 3-month follow-up. Forty-five percent (74/164) and twenty-five percent (41/164) of the patients had continued follow-up at 6 and 12 months, respectively. Of the 127 patients who returned for follow-up, their commonest baseline symptoms were lethargy (92%), bloating (91%), flatulence (91%), and abdominal pain (89%). All symptoms were significantly improved at the initial follow-up (p
METHOD: A randomized controlled trial was conducted recruiting patients from Hospital Melaka, Malaysia. Postoperative TKA patients with good hearing and visual acuity, fully conscious and prescribed with patients controlled analgesia (PCA) were randomized to either intervention or control groups using a sealed envelope. Patients in the intervention group received usual care with additional music therapy during recovery, while patients in the control group received the usual care provided by the hospital. Two factors identified affecting mental well-being were the pain (measured using numerical rating scale) and anxiety (measured using a visual analog scale) at five different minutes' points (0, 10, 20, 30, and 60).
RESULTS: A total of 56 (control: 28, intervention: 28) postoperative TKA patients consented in the study. There was no difference in baseline characteristics between the two groups (p>0.05). Using Mann-Whitney U tests, patients in music therapy group showed significantly lower numerical pain score at 60min (p=0.045) whereas there was no significant difference between the two groups at all time points for anxiety scores (p>0.05). In the intervention group, Friedman tests showed that there was a significant difference in numerical pain (χ2=36.957, df=4, p<0.001) and anxiety score across times (χ2=18.545, p=0.001).
CONCLUSIONS: This study found that pain score decreases over time among patients in the music therapy group while no effect is seen for anxiety. It is suggested that music therapy could not affect postoperative TKA patients' mental well-being. Nonetheless, patients reported better pain score despite the small sample.
Methods: Seven patients with acute grade 1 ankle sprain (15 days of ankle sprain) were recruited. They were provided with 7 days of protection, optimal loading, ice, compression, and elevation (POLICE) treatment, and the standard physiotherapy programme consisted of towel stretching and balancing exercises on one leg. Pain scale score was recorded daily during the physiotherapy programme. The isokinetic ankle strengths of the patient's injured and uninjured legs were compared before and after the physiotherapy programme. Isokinetic tests were conducted in painless range of motion for the injured leg.
Results: Pain was significantly reduced after the patients underwent the standard physiotherapy programme. No significant differences were observed in terms of the ankle peak torque, time to peak torque, and ankle plantar flexion-to-dorsiflexion ratio of the injured and uninjured legs. The injured leg showed significant improvement in terms of ankle eversion-to-inversion ratio (E:I) after 7 days of performing the standard physiotherapy programme.
Conclusion: Performing the standard physiotherapy programme for 1 week reduces pain and improves the ankle E:I in patients with grade 1 ankle sprain.
DESIGN/METHODOLOGY/APPROACH: Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.
FINDINGS: Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 - 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 - 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 - 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 - 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 - 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 - 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 - 1.818; p<0.001).
PRACTICAL IMPLICATIONS: With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.
ORIGINALITY/VALUE: Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.