MyMedR

Establishing learning curve for Tenckhoff catheter insertion by interventional nephrologist using CUSUM analysis: how many procedures and in which situation?

Goh BL, Ganeshadeva Yudisthra M, Lim TO

Semin Dial, 2009 Mar-Apr;22(2):199-203.

PMID: 19426429 DOI: 10.1111/j.1525-139X.2008.00536.x

Peritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single-center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure rate (i.e., catheter malfunction within 1 month of insertion) was defined at >40% and acceptable performance was defined at <25%. CUSUM chart showed the learning curve of a trainee in acquiring new skill. As the trainee became more skillful with training, the CUSUM curve flattened. Technical proficiency of the trainee nephrologist in performing peritoneoscope Tenckhoff catheter insertion (<25% primary catheter malfunction) was attained after 23 procedures. We also noted earlier in our program that Tenckhoff catheters directed to the right iliac fossae had poorer survival as compared to catheters directed to the left iliac fossae. Survival of catheters directed to the left iliac fossae was 94.6% while the survival for catheters directed to the right iliac fossae was 48.6% (p < 0.01). We advocate that quality control of Tenckhoff catheter insertion is performed using CUSUM charting as described to monitor primary catheter dysfunction (i.e., failure of catheter function within 1 month of insertion), primary leak (i.e., within 1 month of catheter insertion), and primary peritonitis (i.e., within 2 weeks of catheter insertion).

Matched MeSH terms: Follow-Up Studies

Fibrin adhesive is better than sutures in pterygium surgery

Ratnalingam V, Eu AL, Ng GL, Taharin R, John E

Cornea, 2010 May;29(5):485-9.

PMID: 20308876 DOI: 10.1097/ICO.0b013e3181c29696

To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery.

Matched MeSH terms: Follow-Up Studies

Primary herpes virus keratitis after penetrating keratoplasty

Hassan M, Patel DK, Subrayan V

Ann Ophthalmol (Skokie), 2009;41(3-4):203-5.

PMID: 20214058

We present a case of a newly acquired herpetic infection in the graft after penetrating keratoplasty.

Matched MeSH terms: Follow-Up Studies

Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population

Collaris R, Sidhu K, Chan JM

Menopause, 2010 Mar;17(2):351-8.

PMID: 19890223 DOI: 10.1097/gme.0b013e3181bcd6f8

Surgical menopause, in comparison with natural menopause, has traditionally been claimed to lead to faster onset of more severe menopausal symptoms. There is little prospective research to support this view. We aimed to evaluate the speed of onset and magnitude of climacteric symptoms after oophorectomy and whether they relate to serum hormone changes. This would aide in counseling women before surgery.

Matched MeSH terms: Follow-Up Studies

Fulltext Targeting health disparity in breast cancer: insights into women's knowledge of their cancer profile in Malaysia

Loh S, Packer TL, Yip CH, Passmore A

Asian Pac J Cancer Prev, 2009 Oct-Dec;10(4):631-6.

PMID: 19827884

OBJECTIVE: Poor health literacy is positively associated with poorer quality of health decision-making and health outcomes in women facing a cancer diagnosis. In developing countries, poor access to complete and accurate information continues to pose a challenge for women. This paper describes the knowledge of Malaysian women with regard to breast cancer and how participation in a self-management program can improve the situation.

METHODS: Secondary analysis of data collected during a clinical trial on women newly diagnosed with breast cancer (n=147) was performed to examine baseline knowledge of breast cancer profile. Knowledge levels of women in the experimental (n= 69) group attending a self-management program were compared to a control group (n= 78) to determine change in the level of knowledge over time.

RESULTS: At baseline, a high percentage of women were unaware of their breast cancer profile. Not a single woman had knowledge of all six basic characteristics; 83% did not know their HER2 status, type of breast cancer (68%), grade of cancer cell (64%), hormonal receptor status (55%), size of breast cancer (18%) and/or their stage of breast cancer (13%). At post intervention, there was significantly better knowledge within the experimental group.

CONCLUSION: Malaysian women in this cohort study demonstrated very low levels of knowledge of their cancer profile. Clinical implications for countering treatment-decision difficulties include the need for a shift in the way information and services are delivered to allow women to take a more active role in their own care. Multi-modal efforts including basic information dissemination to increase women's knowledge can contribute to narrowing of the gap in health disparity.

Matched MeSH terms: Follow-Up Studies

Occult open globe injury in a patient with corneal foreign body: a case report

Kah TA, Salowi MA, Tagal JM, Thanaraj A, Premsenthil M, Gudom Ia

Cornea, 2009 Dec;28(10):1164-6.

PMID: 19770717 DOI: 10.1097/ICO.0b013e31819aa9d9

To demonstrate the role of ultrasonographic biomicroscopy in diagnosing occult open globe injury.

Matched MeSH terms: Follow-Up Studies

Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation

Chan CK, Saw A, Kwan MK, Karina R

J Orthop Surg (Hong Kong), 2009 Apr;17(1):19-22.

PMID: 19398787

To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.

Matched MeSH terms: Follow-Up Studies

A low-GI diet is associated with a short-term improvement of glycaemic control in Asian patients with type 2 diabetes

Yusof BN, Talib RA, Kamaruddin NA, Karim NA, Chinna K, Gilbertson H

Diabetes Obes Metab, 2009 Apr;11(4):387-96.

PMID: 19175374 DOI: 10.1111/j.1463-1326.2008.00984.x

AIMS: The aim of this study is to compare the efficacy of low glycaemic index (GI) vs. conventional carbohydrate exchange (CCE) dietary advice on glycaemic control and metabolic parameters in patients with type 2 diabetes.
METHODS: A total of 104 patients with type 2 diabetes were randomly assigned to either a low GI (GI) or CCE dietary advice over a 12-week period. The primary end-point was glycaemic control as assessed by glycated haemoglobin A1c (HbA1c), fructosamine level and plasma glucose. The secondary end-points were anthropometric measurements and metabolic parameters that include blood pressure, lipid profile and insulin levels. The oral antidiabetic medications remained unchanged throughout the duration of the study.
RESULTS: A low-GI diet was associated with significant changes in the fructosamine level (DeltaGI = -0.20 +/- 0.03; DeltaCCE = -0.08 +/- 0.03 mmol/l, p < 0.01) and waist circumference (DeltaGI group = -1.88 +/- 0.30 cm; DeltaCCE group: -0.36 +/- 0.4 cm, p < 0.05) at week 4. At week 12, the changes in fasting glucose (DeltaGI = -0.03 +/- 0.3; DeltaCCE = 0.7 +/- 0.3 mmol/l; p < 0.05) and waist circumference (DeltaGI = -2.35 +/- 0.47 cm; DeltaCCE group = -0.66 +/- 0.46 cm; p < 0.05) in the GI group was significantly lower than the CCE group. With the low-GI diet, the changes in postprandial glycaemia at time 0, 60, 150 and 180 min after consuming the standard test meal was lower than with the CCE diet (p < 0.05). No significant differences were found between the groups for the remaining parameters that were measured.
CONCLUSIONS: Use of a low-GI diet resulted in significant changes of serum fructosamine level, plasma glucose and waist circumference in Asian patients with type 2 diabetes over a 12-week period compared with those following a CCE diet. The effect on HbA1c and other metabolic parameters was not significantly different between the two study groups but the improvement within the GI group was more pronounced and of clinical benefit.

Matched MeSH terms: Follow-Up Studies

Bovine pericardium in treating large corneal perforation secondary to alkali injury: a case report

Khanna RK, Mokhtar E

Indian J Ophthalmol, 2008 8 20;56(5):429-30.

PMID: 18711278

To describe use of a locally processed bovine pericardium (BP) to cover a large central corneal perforation following alkali injury and discuss postoperative outcome. A 27-year-old Malay male patient presented two weeks after alkali splashed in his left eye while working. A clinical diagnosis of left central corneal ulcer with limbal ischemia following alkali injury with secondary infection was made. After failed medical therapy, we performed a Gunderson conjunctival flap under local anesthesia that retracted after one week and resulted in a large central corneal perforation with surrounding stromal thinning. The perforation was covered with a locally processed BP xenograft (Lyolemb) supplied by the National Tissue Bank, University Sains Malaysia. Nine months follow-up showed a well-taken graft without any exposure/dehiscence and minimal inflammation. Amniotic membrane transplantation when used as a patch graft needs an urgent tectonic graft to promote corneal stability in patients with severe corneal thinning. The use of processed BP can be a viable option in treating such cases.

Matched MeSH terms: Follow-Up Studies

Hypertension, concurrent cardiovascular risk factors and mortality: the Singapore Cardiovascular Cohort Study

Lee J, Ma S, Heng D, Chew S, Hughes K, Tai E

J Hum Hypertens, 2008 Jul;22(7):468-74.

PMID: 18337755 DOI: 10.1038/jhh.2008.16

The current hypertension (HTN) guidelines recommend the assessment of other cardiovascular disease (CVD) risk factors in individuals with HTN for further management. Few studies in Asian populations have been published to identify the outcome of individuals with HTN and other CVD risk factors. This study aims to assess the effect of HTN alone, and in combination with other CVD risk factors on all-cause and CVD mortality. Three cross-sectional studies carried out in Singapore (baseline 1982--1995) consisting of 5830 persons were grouped by the absence or presence of HTN and CVD risk factors. They were followed-up (mean 14.1 years) by linkage with the National Death Register. Cox's proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of mortality. HTN individuals with either <2 CVD risk factors (adjusted HR 1.4; 95% confidence interval (CI) 1.0-1.8) or > or =2 CVD risk factors (adjusted HR 2.3; 95% CI 1.9-3.0) were at increased risk of all-cause mortality compared to normotensive individuals. The findings were similar for CVD mortality. HTN individuals who also smoked or had diabetes were at highest risk of all-cause mortality, whereas those with elevated total cholesterol/high-density lipoprotein cholesterol, smoked or diabetes had the highest risk for CVD mortality. These findings show that in HTN individuals it is important to assess the presence of other CVD risk factors and manage accordingly.

Matched MeSH terms: Follow-Up Studies

Outcome study of first-episode schizophrenia in a developing country: quality of life and antipsychotics

Chee KY

Soc Psychiatry Psychiatr Epidemiol, 2009 Feb;44(2):143-50.

PMID: 18642120 DOI: 10.1007/s00127-008-0415-0

AIM: Quality of life has recently been emphasized in the management of schizophrenia, yet data from developing country is lacking. We explored the differences in subjective quality of life between conventional antipsychotics (CAs) and atypical antipsychotics (AAs).

METHODS: This is a naturalistic study conducted in Kuala Lumpur, Malaysia. Patients with first-episode schizophrenia and related psychosis were recruited from Kuala Lumpur Hospital. WHOQOL-BREF, side effects of medications and other variables were assessed after 1 year of treatment in routine clinical situation.

RESULTS: The study comprised 120 adults. There were no significant statistical differences between groups concerning subjective quality of life, extrapyramidal side effects and employment. Significant less benzhexol usage was reported among AAs (P<0.001) compared to CAs and sulpiride.

CONCLUSION: Patients treated with CAs, sulpiride or AAs experienced similar quality of life, clinical and health outcomes after 1 year commencing treatment. Overall, the results are in line with other major pragmatic clinical trials. This study also found sulpiride cost-effective.

Matched MeSH terms: Follow-Up Studies

Fulltext Trial of labor after one cesarean: role of the order and number of prior vaginal births on the risk of emergency cesarean delivery and neonatal admission

Tan PC, Subramaniam RN, Omar SZ

Taiwan J Obstet Gynecol, 2008 Sep;47(3):305-11.

PMID: 18935994 DOI: 10.1016/S1028-4559(08)60129-1

To evaluate the influences of mode of immediate preceding delivery and number of prior vaginal births on the risk of repeat cesarean and neonatal admission at attempted vaginal birth after cesarean.

Matched MeSH terms: Follow-Up Studies

The association between maternal periodontitis and low birth weight infants among Malay women

Saddki N, Bachok N, Hussain NH, Zainudin SL, Sosroseno W

Community Dent Oral Epidemiol, 2008 Aug;36(4):296-304.

PMID: 19145718

OBJECTIVES: Maternal periodontitis has been suggested as one of the risk factors for low birth weight (LBW) infants. The objective of this study was to determine the association between maternal periodontitis and LBW infants among Malay women.

METHODS: Screening periodontal examinations were carried out on all eligible Malay pregnant women in the second trimester of pregnancy attending two randomly selected community maternal and child health clinics in Kota Bharu, Kelantan. Patients with four or more sites with pocket depth 4 mm or higher, and clinical attachment loss 3 mm or higher at the same site with presence of bleeding on probing were diagnosed as having periodontitis in this study. Using this definition, systematic random sampling was utilized for selection of 250 subjects for each exposed and non-exposed group. Of 500 subjects enrolled in the study, 28 (5.6%) were either dropped or lost to follow-up. Of the remaining 472 subjects, 232 with periodontitis were in the exposed group and 240 with healthy periodontium were in the nonexposed group.

RESULTS: The incidence of LBW was 14.2% (95% CI: 9.70-18.75) in women with periodontitis, and 3.3% (95% CI: 1.05-5.62) in women without periodontitis. The relative risk of having LBW infants was 4.27 times higher for women with periodontitis compared with those without periodontitis (95% CI: 2.01-9.04). After adjustment for potential confounders using multiple logistic regression analysis, significant association was found between maternal periodontitis and LBW (OR = 3.84; 95% CI: 1.34-11.05).

CONCLUSION: The results of this study provide additional evidence that pregnant women with periodontitis are at a significantly higher risk of delivering LBW infants.

Matched MeSH terms: Follow-Up Studies

Delayed diagnosis of cutaneous Rosai-Dorfman disease with distinctive histologic features in a Malayan man

Choon SE, Moktar Z, Ghani GA

Arch Dermatol, 2008 Jan;144(1):120-1.

PMID: 18209186 DOI: 10.1001/archdermatol.2007.19

Matched MeSH terms: Follow-Up Studies

A follow-up study on the effects of a milk supplement on bone mineral density of postmenopausal Chinese women in Malaysia

Ting GP, Tan SY, Chan SP, Karuthan C, Zaitun Y, Suriah AR, et al.

J Nutr Health Aging, 2007 Jan-Feb;11(1):69-73.

PMID: 17315084

A previous study on a randomized controlled trial in 173 postmenopausal Chinese women in Kuala Lumpur showed that milk supplementation was effective to reduce bone loss at the total body, lumbar spine, femoral neck and total hip compared to the control group on a usual diet (Chee et al. 2003).

Matched MeSH terms: Follow-Up Studies

Frontoethmoidal encephalocele: treatment and outcome

Arshad AR, Selvapragasam T

J Craniofac Surg, 2008 Jan;19(1):175-83.

PMID: 18216685 DOI: 10.1097/scs.0b013e3181534a77

This is a study on 124 patients who were treated by the authors over a 19-year period. There were 48 male and 76 female patients. The age range of these patients at the time of treatment was between 4 months and 32 years. There was no family history of similar deformity. All of these patients come from a socially low-income group. Fourteen patients had accompanying congenital amputation of fingers, toes, or limbs. Two had oral cleft lip and palate. The surgical treatment was medial orbital wall osteotomy and excision of encephalocele. There were two mortalities and five patients who had complications that needed secondary surgical intervention. Thirty-eight patients are still under follow up without any complaints.

Matched MeSH terms: Follow-Up Studies

Fulltext Quantitative and qualitative evaluation of sural nerve graft donor site

Ng SS, Kwan MK, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:13-7.

PMID: 17600987

This study is designed to evaluate twenty patients after sural nerve harvest using the single longitudinal incision method. The area of sensory loss to pin prick was assessed by the authors at different intervals. Donor site factors, scar cosmesis, functional status and complications were assessed using a questionnaire. The mean area of anaesthesia at one month was 65 cm2 and it had reduced by 77% to 15 cm2 at one and a half years. The mean area of reduced sensation was 49 cm2 at one month and it increased by 18% to 58 cm2 over the same period. Therefore, the total area of sensory deficit was reduced by 36% from 114 cm2 at one month to 73 cm2 at one and a half years. Subjective patient evaluation indicated moderate level of pain during immediate post surgical period, which reduced significantly at one month. A low level of neuroma symptoms was recorded throughout the study period. At a mean follow-up period of two years, there was no area of anaesthesia in 50% of the patients. Mean area of anaesthesia for all patients was 12 cm2 and mean area of reduced sensation was 55 cm2. Subjective patient evaluation indicated a low level of pain, neuroma symptoms and numbness over the sural nerve sensory distribution. Twenty five percent of the patients were not satisfied with the scar appearance. Function and daily activities were not affected significantly. No surgical complications were observed.

Matched MeSH terms: Follow-Up Studies

Fulltext Use of gentamicin impregnated POP discs for antibiotic pouch dressing

Lau CP, Chee EK, Thirumal M

Med J Malaysia, 2006 Dec;61 Suppl B:32-6.

PMID: 17600990

Antibiotic pouch technique is commonly used due to the high local antibiotic concentration and moist environment for wound healing. We used locally made gentamicin impregnated Plaster of Paris discs in treating wounds with exposed deep structures like tendons and bones. Out of 22 patients treated with this method, 19 completed treatment. Granulation tissue formed quickly and effectively covered the exposed structures. All wounds either healed by secondary intention or became suitable for split skin grafting. Gentamicin impregnated Plaster of Paris disc pouch dressing is safe, cost saving, and effective for management of deep open wounds.

Matched MeSH terms: Follow-Up Studies

Fulltext Chronic posterolateral rotatory instability of the knee

Yong CK

Med J Malaysia, 2006 Dec;61 Suppl B:27-31.

PMID: 17605179

Posterolateral corner (PLC) laxity of the knee results in rotatory instability, in association with posterior cruciate ligament (PCL) laxity led to a grossly unstable knee. This is a series of eight patients with chronic PLC and PCL laxity treated with arthroscopic quadriceps tendon PCL reconstruction and extraarticular hamstring PLC reconstruction. Seven cases had high tibial osteotomy to address associated genu varus deformity. With prospective pre- and post-operative assessments, there was a significant improvement in the 2000 International Knee Documentation Committee (IKDC) subjective assessment and knee examination, Lysholm-Gillquist and Tegner activity scores, as well as KT-1000 arthrometry measurement after one year in all knees. Surgical treatment of PLC laxity must address coexisting problems of the PCL and mechanical alignment for a successful outcome.

Matched MeSH terms: Follow-Up Studies

Heart failure mortality in Southeast Asian patients with left ventricular systolic dysfunction

Seow SC, Chai P, Lee YP, Chan YH, Kwok BW, Yeo TC, et al.

J. Card. Fail., 2007 Aug;13(6):476-81.

PMID: 17675062

Prognostic indicators and mortality in multiethnic Southeast Asian patients with heart failure (HF) may be different.

Matched MeSH terms: Follow-Up Studies

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