The level of patient satisfaction is important for service quality in hospitals. This study aims to measure the level of patient satisfaction at University Kebangsaan Malaysia Medical Centre (UKMMC) and the factors affecting it. A cross-sectional study was conducted on 520 respondents at the outpatient department in four clinics in UKMMC by using self-administered questionnaires. Respondents were selected using a systematic sampling method based on the list of patient appointments. The level of patient satisfaction was measured using the PSQIII domain. Less than half of the respondents were satisfied with the overall service provided (41.0%), while the others (59.0%) were not satisfied. Based on the domain studied, the level of satisfaction varies widely: the highest satisfaction were interpersonal relationships (75.8%) followed by the registration process (73.8%), technical quality (71.3%), communication (66.7%), physical facilities (64.6%), accessibility (60.2%), and financial (47.3%). The level of patient satisfaction was low and financial domain should be given more attention to in order to ensure an increase in patient satisfaction levels.
Study site: Surgery, Orthopaedic, Obstetric and Gynaecology, and Medical clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
Introduction: Family Environment Scale (FES) was developed by Moos1, has ten subscales and was categorized into three dimensions.Objective:The objective of this study was to develop factor structure for the Malay-translated version of the FES subscales. Methodology: The study used Malay translated version of FES by Khairani et. al2. This study was a multi centre, cross-sectional study, involving four secondary schools consisted of adolescents, aged between 12-17 years old and a total of 295 participants were enrolled in this study. Exploratory factor analyses was done across two groups of analysis set on the subscales with Cronbach’s alpha more than 0.50 and 0.53 respectively. Results: Two distinct factors were extracted across the four subscales consisted of Cohesion, Conflict and Organization in factor 1 and only Control in factor 2. Conclusion: The finding indicated that element of Cohesion, Conflict and Organization has a good indicator of a good family relationship.
Introduction: To determine the effectiveness of the enhance enforcement programmes (The Ops) on the percentage of seatbelt wearing among front occupants in Malaysia.
Methodology: The roadside observations for measuring the seatbelt wearing among front occupant were conducted before, two weeks and six months after the Ops. The study was conducted in selected states representing four different zones (Northern, Southern, Eastern and Central zones) of Peninsular Malaysia.
Result: A total of 12,298 drivers and 11,212 front occupants were observed for their seatbelt wearing status through out the study. Percentage of seatbelt wearing among drivers and front passengers were increased from the baseline of 82.6 % and 74.4 % to 92 % (95 % CI: 91.2, 92.7) and 87.0 % (95 % CI: 85.9, 88.0) after two week, but declined to 85.7 % (95 % CI: 84.4, 86.8) and 76.8 % (95 % CI: 75.2, 78.3) after six months of the Ops respectively. Pre and post analysis revealed that after 2 weeks, the Ops were significantly effective in increasing the seatbelt wearing among front passengers and drivers with the RR (95 % CI) of 1.17 (1.14, 1.20) and 1.12 (1.10,1.13) respectively. However, after six months, the effectiveness of the Ops was reduced for both type of vehicle occupant.
Conclusion: This study sheds light on the importance of the enhance enforcement programme for increasing the seatbelt wearing in Malaysia. However, in order to give more impact on seatbelt wearing, the strategy and the frequency of the enhance enforcement programme in Malaysia may need to be revised.
The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.
Barium strontium titanate (Ba0.7Sr0.3TiO3) powder was processed at temperature 80 o C by reacting titania sol in aqueous solutions that contained BaCl2, SrCl2 and NaOH at atmospheric pressure.
The structural characteristic of the powder and sintered pellet were studied using Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD) whereas the electrical characteristic was determined via Impedance Spectroscopy (IS) and LCR meter. The synthesized powder was found to have a tetragonal phase after heating at 1300 o C. XRD pattern also showed the presence of secondary phase BaTi2O5 (BT2). The SEM results shows the fine grain size was in the range of 0.2 Pm to 0.4 Pm whereas the large ones are approximately 0.8 Pm to 1.2 Pm The ac response of sample sintered at 1300 o C indicated that three electrically different regions. Element 1 can be assigned as a ferroelectric grain boundary region and it is actually BT2, element 2 as a ferroelectric bulk region and the third element is a conductive core which has a low resistance (200 :) and capacitance value.
Tetragonal Y2O3 stabilized Zirconia (t-Y-ZrO2) powders were doped with Nb2O5 to seek a possibility if electronics doping would enhance the electronics conductivity of the insulating oxide. In this work Y2O3 was added as a stabilizer to produce tetragonal ZrO2 whereas Nb2O5 was added for the electronic doping. Several compositions of powders were prepared by thermal decomposition method and were post annealed at different temperatures. Precursor solutions were prepared from the mixture of zirconyl nitrate, yttrium nitrate and niobium tartarate as well as TEA (triethanolamine). The mixed solution were evaporated, pyrolysed and calcined to produce nanosized powders. The phase formation of the as-made powders was investigated by x-ray diffractometer. The additions of 7% Y2O3 were found to stabilize the tetragonal phase of zirconia.
The addition of Nb2O5 did not alter the stability of the tetragonal phase but it was found that the conductivity of the material has changed. The band gap as measured by the UV-Visible Spectrometer gave a value in the range of 2.97 to 5.01 eV. XRD was also used to deduce the crystallite size (by using Scherer’s equation) and transmission electron microcopy was used to view the particle sizes and shapes. The Nb doped t-Y-ZrO2 prepared in this work was to be nanosized crystal with size ranges from 7 nm to 15 nm.
Part of the Seremban flood mitigation project in the state of Negeri Sembilan, Malaysia is to mitigate
the flood at Jalan Rasah. The mitigation is planned to be implemented in packages. Package I and Package II of River Anak Air Rasah are parts of the project work. In these packages, wider and deeper concrete sections for the river are constructed. The existing undersized culverts were replaced by bigger reinforced concrete box culverts. The size of the box culverts was based on 100-years average reoccurrence interval (ARI). One of these culverts intersected with a rail line connecting Singapore and Malaysia. Trenchless jacking technique was used to lay the box culvert. The total length of the box culvert jacked under the railway line is 33 m, whereas the total width of the twin box culvert is 7.8 m with a total height of 3 m. This was the first time that the trenchless jacking techniques were used for the urban flood mitigation purpose in Malaysia, and it is mainly used to minimise traffic disruption. This study reports the success of using jacking technique in the development of the flood mitigation program of DID in Negeri Sembilan. Among other things, it explains significant performance of the technique under local conditions and experiences gained towards the advancement of tunnelling and trenchless technology.
The production of carbon dioxide from Karas woods under argon atmosphere was investigated using a direct pyrolysis-combustion approach. Direct burning was used in this study, using argon for yrolysis and oxygen during combustion to look at the yield of carbon dioxide, produced at different parameters, such as the temperature, retention time and flow rate of argon, as the carrier gas. In this study, a new methodology, 23 response surface central composite design was successfully employed for the experimental design and analysis of results. Central composite experimental design and response surface method were utilized to determine the best operating condition for a maximum carbon dioxide production. Appropriate predictable empirical linear model was developed by incorporating interaction effects of all the variables involved. The results of the analysis revealed that linear equation models fitted well with the experimental for carbon dioxide yield. Nevertheless, the R-Squared obtained using the direct pyrolysis-combustion was 0.7118, indicating that the regression line was not at the best-fitted line.
Perkembangan kognitif dan pertumbuhan fizikal di kalangan kanak-kanak bergantung kepada status pemakanan mereka, termasuklah tabiat pengambilan sarapan pagi. Objektif kajian ini adalah untuk melihat pengaruh pengambilan sarapan pagi sebelum ke sekolah ke atas pencapaian kognitif kanak-kanak sekolah rendah. Satu kajian hirisan lintang dijalankan di kalangan kanak-kanak sekolah rendah di bandar dan luar bandar. Subjek kajian mengandungi 165 pelajar Melayu yang berusia 10 tahun. Tiga jenis subskala daripada ujian Wechsler Wechsler Intelligence Scale For Children-III digunakan untuk mengukur tahap kognitif kanak-kanak tersebut iaitu arithmatik, pengkodan dan digit span. Hasil kajian didapati kanak-kanak yang mengambil sarapan pagi mencatatkan pencapaian yang tinggi secara signifikan dalam arithmetik (p
Hysterectomy is one of the most common non-obstetric surgical procedures performed on women. Little is known about the factors affecting decision making process regarding hysterectomy in Malaysia. The study aimed to explore factors affecting women decision regarding hysterectomy among Malaysian women. This study has enrolled 100 women eligible for hysterectomy in the department of general gynecology ward in the university of Malaya hospital, Malaysia. A structured questionnaire was administered by interview. Descriptive analysis was used to obtain the frequencies. Chi square test and simple logistic regression test were performed to assess the association between variables. The majority of participants aged 41-50 years (52%) and married (74%). Twenty seven out of 100 participants made their decision on the operation within one month while 73 women decided after one month. Some complications were only known by the minority of patients such as injury to ureter (47%), injury to nerve (8%), incision hernia (18%), vault prolapse (21 %), and deep vein thrombosis (43%). Most of women delay their decision on the surgery (73%). Factors associated significantly with decision were ethnicity, religion, knowledge on complication, discussion with spouse and doctor.. Cultural factors, opinion of husband and doctors and knowledge of the complication play an important role in the decision of women. It is important to provide suitable information and social support for patients to help them in their decision-making. Participation and support from spouses and doctors should also be encouraged.
Substantial studies reported musculoskeletal disorders among the working population in the developed country, however, a limited number of studies were conducted in Malaysia. The objective of this cross sectional study was to determine the physical activity risk factors for low back pain among automotive workers in Selangor. Modified Risk Factors Questionnaire (RFQ) was used to assess physical activity with the occurrence of low back pain. The significant physical activities associated with the 12 months point prevalence are lifting weight (
Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and
DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.
Introduction: An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. The Spetzler-Martin grading system has been widely accepted worldwide to estimate the pretreatment risks and predict the outcome of patients with intracranial AVM. In Malaysia, we still do not have the baseline data of this grading system. Methods: A total of 33 patients from a tertiary referral hospital diagnosed with intracranial AVM based on neuroimaging findings over a 4-year period were studied. Medical
records were traced and neuroimaging findings were analysed. The AVMs were graded according to the Spetzler-Martin grading system and Fisher’s exact test was used to assess statistical difference between the grades of the AVM and management plan for the patients. Results: Four patients were graded as Grade 1, 9 patients as Grade II, 10 patients as Grade III, 6 patients as Grade IV and 4 patients as Grade V. Ten patients were treated conservatively; six patients underwent surgery and embolisation respectively. Four patients underwent radiosurgery and a combination of embolisation while surgery and radiosurgery were given to 5 patients and 2 patients respectively. Statistically significant difference (p=0.016) was found between the Spetzler-Martin grading system and the management of intracranial AVMs. Conclusion: The management decision was not made based on the
grading of the AVMs. It is recommended that all AVM patients be routinely graded according to this system prior to treatment.
Introduction: As eating disorders such as anorexia nervosa and others are generally becoming more prevalent, it is essential to have a culturally accepted and locally validated questionnaire that is able to detect abnormal eating habits. Objective: To translate the Eating Disorders Examination Questionnaire (EDE-Q) into Bahasa Malaysia (BM) and to determine the construct validity, reliability and other psychometric properties of the BM version. Method: Two parallel forward and backward translations were done in BM in accordance to guideline. Its validation was determined by using confirmatory factor analysis among 298 secondary school children. Results: The BM EDE-Q had very good internal consistency with global Cronbach’s alpha value of 0.879. For construct validity, majority of the items managed to produce values of more than 0.4 for confirmatory factor analysis with four unforced distinct factors detected. Conclusions: Analyses of reliability and validity of this BM version of EDE-Q yielded satisfactory results. The BM version produced in this study had good psychometric properties and it is applicable to the Malaysian population. Findings indicated that cultural factors in eating habits certainly influences the effort to adapt the questionnaire within a Malaysian setting.
Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems.
Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, metaanalyses, case reports, and review articles.
Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline.
Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.
Spatial and temporal variations in concentrations of several metals and isotopes in sediment cores from around Penang Island, an area with economically important biological resources off the northwest coast of peninsular Malaysia, are reported. Because of a typical, monazite rich mineralogy in surrounding drainage basins, sedimentary metal enrichment factors relative to global average materials, enrichment factors (EFs) of ˃1.0 do not always indicate significant anthropogenic metal inputs. Because of extensive metal solubilization in the hot, organic carbon rich area, EFs of < 1.0 may be observed for several metals despite significant anthropogenic contributions. Comparison of metal-Al relationships in Penang area surface sediments with those in nearby and presumed uncontaminated Strait of Malacca sediments more accurately correct for atypical regional solubilization and mineralogical effects than comparison to global average materials. Such comparisons show concentrations of Cd, Cu, Pb, Ni, Cr, As, Sb, Zn and V have changed by less than a factor of two by anthropogenic discharges. Sedimentary concentration profiles of Pb, Zn and Cu, ratioed to Sc to normalize for variations in grain size and mineralogy, have subsurface maxima suggestive of modest and recently reduced anthropogenic inputs. Mn, U, As and Sb have Sc-normalized concentration profiles clearly affected by diagenetic processes. Sc-normalized profiles of Cr, Th, Ce and Sm show only small changes with depth, confirming insignificant anthropogenic inputs and undetectable postdepositional diagenetic mobility.
Excess ²¹⁰Pb activities and fluxes in Penang area sediments are limited by supply of this radionuclide, in contrast to sediments of both the northwestern U.S.A. and Amazon continental shelves, where they are limited by particle scavenging reactions.²¹⁰Pb activities in sediments of
the shallow, dynamic Penang area often show erratic or unconvincing changes with depth that
cannot be reliably modeled by assuming steady state, constant deposition rate of particles of
uniform chemistry, mineralogy and initial unsupported ²¹⁰Pb, and that mixing is limited to a
recognizable surface layer and resemble a diffusive process.
We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.
Top-down costing and activity based costing are the most frequent costing methodologies used for analyzing cost. Top-down costing is accomplished by assigning total expenditure of hospital to patient by apportioning the expenditure of cost centers (unit of service) in hospital to give the cost per patient per visit, per day or per admission. Conversely, activity based costing is accomplished by tracking every resource used by patient individually. Since this study started in 2009, Top-down costing calculation was based on financial year in 2009 with adjusted up to 12.6% from 2008 data. This percentage was taken based on the trend of hospital expenditure during 2005 till 2008. An assumption was made that non-financial data (performance and administrative data) for 2009 was similar to 2008. Top-down costing was calculated using Clinical Cost Modeling Software developed by Unit Case-mix of UKMMC to obtain cost of elective lower segment caesarean section (LSCS) per day at ward which was RM922. Whereas activity based costing was calculated using clinical pathway of elective LSCS. Given the average length of stay in 2009 was 4 days, the cost of elective LSCS according to top-down costing was RM3, 688 and activity based costing was RM1774. As a result, cost of elective LSCS is 108% higher using top-down costing.
Objective: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p