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Fulltext The usefulness of endothelial cell adhesion molecules and anti-C1q antibody in monitoring systemic lupus erythematosus disease activity

Mahayidin H, Yahya NK, Wan Ghazali WS, Mohd Ismail A, Wan Ab Hamid WZ

Int Sch Res Notices, 2014;2014:275194.
PMID: 27355017 DOI: 10.1155/2014/275194

Objectives. The study was conducted to determine the correlation of ICAM-1, VCAM-1, and anti-C1q antibody levels with SLE disease activity index (SLEDAI) and standard SLE disease activity immunological markers (anti-dsDNA and sera C3 and C4). Study Design. This was a cross-sectional study. Materials and Methods. Blood samples were obtained from 95 SLE patients (45 active SLE and 50 nonactive SLE) and 50 controls. The subjects were assessed using SLEDAI and score of more than five is determined as having active SLE. The sera were tested for serum ICAM-1, VCAM-1, and anti-C1q (ELISA), anti-dsDNA (CLIFT), serum C3, and serum C4 (immunonephelometry). Results. Anti-dsDNA and anti-C1q antibody showed good positive correlations with SLEDAI (r = 0.529, P < 0.001 and r = 0.559, P < 0.001, resp.). VCAM-1 and sera C3 and C4 showed fair correlation with SLEDAI (r = 0.294, P = 0.004; r = -0.312, P = 0.002; and r = -0.382, P < 0.001, resp.). ICAM-1 level showed no significant correlation with SLEDAI (P = 0.062). There were significant correlations of VCAM-1 and anti-C1q antibody with anti-dsDNA (r = 0.226, P = 0.006 and r = 0.511, P < 0.001, resp.). VCAM-1 showed poor inverse correlation with serum C3 (r = -0.183, P = 0.028) and fair inverse correlation with serum C4 (r = -0.251, P = 0.002). Anti-C1q antibody demonstrated fair inverse correlation with both sera C3 and C4 (r = -0.420, P ≤ 0.001 and r = -0.398, P < 0.001, resp.). However, ICAM-1 showed no significant correlation with anti-dsDNA and sera C3 and C4 (P = 0.259, P = 0.626 and P = 0.338, resp.). Conclusions. The serum levels of anti-C1q antibody in SLE patients showed the best correlation with the SLEDAI and standard immunological tests for SLE disease activity. These data support that anti-C1q antibody is a useful marker for monitoring SLE global disease activity. The potential of VCAM-1 needs further confirmation.
Study site: Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, and Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext Polypharmacy in the management of patients with schizophrenia on risperidone in a tertiary-care hospital in Malaysia

Jacob S, Ibrahim MM, Mohammed F

Ment Health Fam Med, 2013 Jan;10(1):37-43.
PMID: 24381653

The present study was conducted primarily to determine the occurrence of polypharmacy in patients with schizophrenia on risperidone. The secondary aim was to ascertain the incidence of inappropriate prescribing with anticholinergics. A retrospective review of the medical records of all patients who were being followed up at the out-patient clinic of a tertiary-care hospital in Malaysia was conducted. Only patients who were being prescribed risperidone between 1 June 2008 and 31 December 2008 were included in the study. Demographic data such as patient's age, gender and race were obtained from the patient's medical records. In total, 113 patients met the selection criteria. Polypharmacy was found to occur in 34 patients (30.09%), with the majority (76.47%) being on two antipsychotics. In total, 27 patients (34.18%) on monotherapy with risperidone were prescribed an anticholinergic on scheduled dosing, while 19 patients (24.05%) were prescribed it on an as-needed basis. Of the patients on polypharmacy, 26 (76.47%) were on scheduled dosing of anticholinergics, while three (8.82%) were taking the medication on an as-needed basis. Polypharmacy should be avoided, and the use of anticholinergics should be closely reviewed. By adopting more efficient prescribing practices, costs can be reduced and financial resources can instead be channelled towards more beneficial areas for the patients.
Study site: Psychiatric clinic, tertiary hospital, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext Direct Medical Costs of Dengue Fever in Vietnam: A Retrospective Study in a Tertiary Hospital

Vo NTT, Phan TND, Vo TQ

Malays J Med Sci, 2017 May;24(3):66-72.
PMID: 28814934 DOI: 10.21315/mjms2017.24.3.8

BACKGROUND: In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision.
METHODS: This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies. Average cost per case and treatment cost across different age was calculated.
RESULTS: In the study period, 1672 patients with dengue fever were hospitalised. The average age was 24.98 (SD = 14.10) years, and 47.5% were males (795 patients). Across age groups, the average cost per episode was USD 48.10 (SD = 3.22). The highest costs (USD 56.61, SD = 48.84) were incurred in the adult age group (> 15 years), and the lowest costs (USD 30.10, SD = 17.27) were incurred in the paediatric age group (< 15 years).
CONCLUSION: The direct medical costs of dengue-related hospitalisation place a severe economic burden on patients and their families. The probable economic value of dengue management in Vietnam is significant.

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
Fulltext A randomised control trial on the use of topical methicillin in reducing post-operative ventriculoperitoneal shunt infection

Theophilus SC, Adnan JS

Malays J Med Sci, 2011 Jan;18(1):30-7.
PMID: 22135571

BACKGROUND: A double-blind randomised control study was conducted on all patients who were admitted or referred to the Department of Neurosurgery, Sultanah Aminah Hospital, Johor Bahru, with a diagnosis of hydrocephalus where a ventriculoperitoneal shunt was indicated.
METHODS: The period of study was from November 2005 to May 2007, and the follow-up period was 3 months after surgery. Randomisation was carried out in the operating room prior to the procedure. The scrub nurse selected a sealed envelope, which contained the assignment of each patient to 1 of 2 treatment groups: Group 1 patients were treated with topical methicillin, and Group 2 patients were not treated with topical methicillin. Prophylactic antibiotic, cefuroxime (25 mg/kg) was given intravenously at induction. Standard sterile operative technique was followed in preparing and draping the patients.
RESULTS: A total of 90 patients were recruited in the study, and 13 (14.4%) patients developed an infection within 3 months post-operation. Group 1 had a 8.9% risk of infection, and Group 2 had a 20% risk; however, there was no statistically significant post-operative ventriculoperitoneal shunt (VPS) infection reduction with the use of topical methicillin in VPS surgery (P = 0.230). Multivariate analysis showed that only duration of surgery had a significant influence on the incidence of post-operative VPS infection in the non-methicillin group (P = 0.02). The non-methicillin group had an 8 times greater risk of developing post-operative VPS infection than the methicillin group if surgery lasted longer than 1 hour.
CONCLUSION: Topical methicillin had no significance in the reduction of post-operative VPS infection.
KEYWORDS: methicillin; neurosurgery; post-operative wound infection; topical administration; ventriculoperitoneal shunt
Study site: Patient admitted or referred to Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext Stomach gastrointestinal stromal tumours (GIST) intussuscepted into duodenum : a case report

Siam FA, Siow SL

Malays J Med Sci, 2008 Oct;15(4):68-70.
PMID: 22589640

Gastrointestinal stromal tumours (GIST) are tumours of gastrointestinal tract and mesentery. The commonest site of its occurrence is the stomach. Patients with GIST are usually asymptomatic but they can present as abdominal pain, bleeding and rarely gastric outlet obstruction. In this particular case, the patient presents with symptoms of anaemia, partial gastric outlet obstruction and intermittent epigastric pain. Laparotomy was performed and a diagnosis of gastroduodenal intussusception secondary to gastrointestinal stromal tumour was made.

Matched MeSH terms: Hospitals, General
Fulltext Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

Minas H, Zamzam R, Midin M, Cohen A

BMC Public Health, 2011;11:317.
PMID: 21569613 DOI: 10.1186/1471-2458-11-317

The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.

Matched MeSH terms: Hospitals, General*
Fulltext Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward

Sim SK, Lim SL, Lee HK, Liew D, Wong A

Med J Malaysia, 2011 Jun;66(2):138-41.
PMID: 22106695 MyJurnal

Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

Matched MeSH terms: Hospitals, General*
Fulltext Characteristic differences in neuroimaging and physical findings between non-accidental and accidental traumatic brain injury in young children. A local experience in general hospital of Kuala Lumpur

Hafiz MZ, Saffari MH

Med J Malaysia, 2011 Jun;66(2):95-100.
PMID: 22106685 MyJurnal

OBJECTIVE: The objective of this study is to identify the characteristic neuroimaging (namely brain CT) as well as physical findings found in young children with nonaccidental traumatic brain injury (TBI) and to compare them with accident cases of the similar age group, in order to study the specific features of the former group more precisely.
MATERIALS AND METHODS: A cross sectional study was done involving 92 children aged 3 years old and below who were admitted to the Kuala Lumpur Hospital with diagnosis of moderate to severe traumatic brain injury from period of June 2007 to September 2009. These children were categorized into non-accidental and accidental TBI and their physical examination data, brain computed tomography and skeletal surveys were done within one week from the date of admission were compared.
RESULTS: There was a male predominance in both non-accidental and accidental TBI groups with male-to-female ratio of 2:1 and 3:1 respectively. The majority of the non-accidental TBI cases presented with no definite history of trauma (52.2%) while most of the accidental TBI cases were caused by motor vehicle accidents (69.9%). Subdural haematomas appeared to be significantly the most common brain haematomas among the nonaccidental TBI as compared to the accidental group while extradural haematomas were only present in the accidental TBI group. Cerebral edema was also significantly more common in the non-accidental group. Signs of pre-existing brain injury, including cerebral atrophy and subdural hygroma/effusion were present in 23.9% and 19.6% respectively among children with non-accidental TBI and in none of the children with accidental TBI. None of the children in the non-accidental group diagnosed to have shear injury while 6 (13.0%) of the children in the accidental group was diagnosed with diffuse axonal injury. In our series, retinal haemorrhage was significantly more common in the non-accidental TBI group (93.5%) as opposed to only 4(8.7%) children noted to have retinal haemorrhage in the accidental group. Seizures also occurred significantly more often in children with non-accidental TBI. Depressed skull fractures were only found in the accidental TBI group (19.6%), while other types of skull fractures occur more or less similar in both groups. Bodily fractures were also more predominant among the accidental group of TBI. Bodily lacerations/abrasions were only found in the accidental group while findings of bodily bruises were quite equal in both groups.
KEY WORDS: Traumatic brain injury, Non-accidental head injury (NAI), Young children

Matched MeSH terms: Hospitals, General*
Fulltext The pattern of spinal tuberculosis in Sarawak General Hospital

Rasit AH, Razak M, Ting FSS

Med J Malaysia, 2001 Jun;56(2):143-50.
PMID: 11771073

This is a retrospective study of 53 patients with spinal tuberculosis treated in Sarawak General Hospital from 1994 until 1998. The study showed that the mean age in patients with spinal tuberculosis was 40.2 years, and was more common in male (70%) and in Iban population (50%). The clinical presentation included backache (94%); abscess (45%); neurological deficit (44%); and gibbus deformity (22%). The percentage of patient without BCG scar was 82% and 18% had evidence of pulmonary tuberculosis. The most common vertebra involved was the ninth thoracic vertebra and the least common was the third cervical vertebra. The average number of vertebra affected per patient was three. The most common radiological type of lesion was paradiscal (47%). The percentage of patients diagnosed by histological examination was 44%. All patients were given chemotherapy for 12 months' duration; 57% were treated surgically and 43% were treated conservatively. Twenty-four of patients (40%) had an excellent and good results and 28 of patients had a fair result and only one patient had poor result. In 23 of patients treated conservatively showed increment of 8 degrees of kyphosis angle and 22 of patients had a fair result and only one patient had poor outcome after 6 months of treatment. In 30 of patients treated surgically showed correction of 4 degrees of kyphosis angle and 24 of them had excellent and good outcome, where 6 of them had fair outcome after 6 months of treatment.

Matched MeSH terms: Hospitals, General/statistics & numerical data*
Fulltext Meningioma--the Sarawak General Hospital experience

Wong SH, Chan SH

Med J Malaysia, 2002 Dec;57(4):467-73.
PMID: 12733172

The aim of this study was to determine the factors for the large size of intracranial meningiomas at the time of presentation to the Sarawak General Hospital. The data was collected prospectively from 1/3/2000 to 28/2/2001. During this period a total of 57 cases of intracranial tumours were operated upon. Twenty of these cases (35%) were meningioma, making meningioma the most common intracranial tumour operated in the Neurosurgery service here with one to two cases operated per month. Headache was the most common symptom. The average duration of symptoms before the diagnosis was made was twenty-five months, the longest being fifteen years. The patients needed an average of seven visits prior to the diagnosis.

Matched MeSH terms: Hospitals, General/statistics & numerical data*
Fulltext Palliative care: experience with 156 cases in a general hospital

Khoo SB

Med J Malaysia, 2002 Dec;57(4):408-17.
PMID: 12733165

The concept of Palliative Care is still quite new in Malaysia and there is a need to promote the awareness of its importance for patients with incurable and advanced illnesses, not only to the public but also to the nursing and medical professionals. These patients especially the poor ones very often have no one to turn to; they cannot afford to seek treatment from the private hospitals, they are turned away from acute General Hospitals and are told that there is nothing more to be done because their illnesses are no longer curable, they cannot pay for GPs to come to their homes, and there is difficulty in purchasing opiate drugs for pain relief. This is a retrospective observational study of the palliative care services we try to provide to those few patients referred to us. This study showed that out of the total of 156 patients, majority were Chinese, peak age between 50-59 years, referrals were mainly from the community and the Obstetrics + Gynaecology department, patients were referred rather late, 60% of patients died at home, most common malignancies being those of the breast, colorectal and cervix, common sites of metastases being the lungs, liver, bones, peritoneum and local infiltration, 87% of patients experienced pain, about 40% of patients were not fully aware of both diagnosis and prognosis, common drugs used being opiate analgesics followed by dexamethasone, H2 antagonist, antiemetics and NSAID.

Matched MeSH terms: Hospitals, General/statistics & numerical data*
Fulltext Independent hospital dialysis in Brunei

Chin SS, Hart PL

Br Med J, 1971 Sep 11;3(5775):629-31.
PMID: 5569986

In establishing a chronic haemodialysis unit in Brunei the difficulties encountered were less insuperable than had been expected. Quite unsophisticated patients successfully dialysed unattended in some cases, or with minimal supervision in others.

Matched MeSH terms: Hospitals, General*
PREVALENCE OF INTESTINAL HELMINTHS AMONG PATIENTS OF THE GENERAL HOSPITAL IN KUALA LYMPKUALA LUMPUR, MALAYA

JOE LK

Trop Geogr Med, 1964 Sep;16:229-37.
PMID: 14208124
Matched MeSH terms: Hospitals, General*
Clinical trials of intravenous tetracycline in traumatic and orthopaedic cases from the orthopaedic unit, General Hospital, Kuala Lumpur

Ismail AM

Med J Malaysia, 1963 Sep;18:59-63.
PMID: 14064300
Matched MeSH terms: Hospitals, General; Hospitals, General*
Fulltext Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study

Lee KY, Wan Ahmad WA, Low EV, Liau SY, Anchah L, Hamzah S, et al.

PLoS One, 2017;12(9):e0184410.
PMID: 28873473 DOI: 10.1371/journal.pone.0184410

INTRODUCTION: The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH).
METHODS: This cross-sectional study was conducted from the healthcare providers' perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test.
RESULTS: The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients' comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost.
CONCLUSIONS: The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.

Matched MeSH terms: Hospitals, General/economics*
Fulltext Asthma guideline knowledge, adherence and cost of treating asthma at emergency department [Abstract]

Khan AH, Syed Sulaiman A, Hassali AA, Saleem F, Aftab RA, Ali I

Value Health, 2014 Nov;17(7):A725.
PMID: 27202576 DOI: 10.1016/j.jval.2014.08.050

Conference abstract:
Objectives: To evaluate physician’s knowledge and adherence to asthma guideline adherence (GINA 2011) at emergency department of Hospital Pulau Pinang, Malaysia and to calculate cost of adhered and non-adhered prescriptions
Methods: A cross-sectional survey was conducted to evaluate knowledge of GINA, 2011 asthma guideline at emergency department of Hospital Pulau Pinang, Malaysia. A total of 810 patient prescriptions of 27 doctors (30 prescriptions per doctor) were viewed to asses doctor’s guideline adherence. Patients’ prescriptions were categorised in terms of asthma severity as mild, moderate and severe. Prescriptions were labelled as adhered or non-adhered in terms of doctor treatment according to patient asthma severity as recommended by CPG (GINA 2011). Cost of adhered and non-adhered was calculated according to asthma severity.
Results: Twenty two (81.5%) doctor’s had adequate GINA, 2011 asthma guideline knowledge (Mean 16.7, SD ± 1.5). Six hundred and twenty eight (77.5%) patients received guideline (GINA 2011) adhered pharmacotherapy. Six hundred and seventy eight (83.7%) patients asthma were classified as mild asthma, 128 (15.8%) patients were classified as moderate asthma and 4 (0.5%) patients were classified as severe asthma. Pearson correlation indicated no statistical significant association between asthma guideline adherence and asthma guideline knowledge score (p=0.27). Univariate analysis indicate that patients with age group 25-35 years and with hypertension as co-morbidity received significantly better pharmacotherapy (p=0.04, p=0.03 respectively). Total cost of 628 adhered prescriptions was RM 5792.87 whereas cost of 182 non-adhered prescriptions was RM 1759.09. Cost of single mild asthma adhered prescription (RM 9.18) was less as compared to non adhered mild asthma prescription (RM 10.39).
Conclusions: Emergency doctor’s had adequate GINA, 2011 asthma guideline knowledge. Majority of patients received GINA, 2011 asthma guideline adhered pharmacotherapy. Cost effective medication can significantly reduce socioeconomic burden related to asthma.

Matched MeSH terms: Hospitals, General
Fulltext Assessment of Inter- and Intra-Audiologist Agreements on Auditory Brainstem Response (ABR) Waves Interpretation and ABR Variability

Dzulkarnain AA, Che Azid N

Med J Malaysia, 2014 Aug;69(4):156-61.
PMID: 25500842 MyJurnal

AIM OF STUDY: This study investigated the consistency in Auditory Brainstem Response (ABR) waveform evaluations between two audiologists (inter-audiologist agreement) and within each of the audiologist (intra-audiologist agreement).
METHODS: Two audiologists from one of the audiology clinics in Kuantan, Pahang, Malaysia were involved in this study. Both audiologists were required to identify and mark the presence of Waves I, III and V in 66 ABR waveforms. Over a one-month interval, each audiologist was required to carry out the same procedure on the same ABR waveforms. This process was continued until we had three separate reviews from each audiologist.
RESULTS: There was a high inter-audiologist ABR waveform identification agreement (over the range 81.71-89.77%), but a lower intra-audiologist ABR waveform identification agreement (over the range 50%-78%) for both audiologists. Our results also showed a high intra-audiologist ABR latency agreement within 0.2 ms (>90%), but a slightly lower inter-audiologist latency agreement (75-84%) within 0.2 ms.
CONCLUSION: Our results support the need for the clinic to implement further strategies for improving the respective lower agreements and consistencies. These include conducting a continuous education program and using an objective algorithm to support their interpretations.

Study site:; International Islamic University, Malaysia (IIUM) Hearing
and Speech Clinic

Matched MeSH terms: Hospitals, General
Modified labels for long-term medications: influences on adherence, comprehension and preferences in Malaysia

Chan HK, Hassali MA

Int J Clin Pharm, 2014 Oct;36(5):904-13.
PMID: 25135804 DOI: 10.1007/s11096-014-0003-1

BACKGROUND: Inability to read instructions on drug labels has been identified among the Malaysian population since 1990's.
OBJECTIVE: To assess the impact of font-enlarged and pictogram-incorporated labels used for long-term medications on patients' adherence, comprehension and preferences.
SETTING: Outpatient pharmacy in one of the major general hospitals across Northern Malaysia.
METHOD: This was a three-arm, randomized controlled trial. Outpatients with refill prescriptions of selected oral antihypertensive or antidiabetic medications were screened for eligibility. They were randomly allocated with standard (n = 35), font-enlarged (n = 40) or pictogram-incorporated (n = 35) labels. Assessment of baseline adherence scores using the 8-item Morisky Medication Adherence Scale, comprehension scores using a structured questionnaire and preferences was conducted upon recruitment. Follow-up telephone interviews were conducted after 4 weeks.
MAIN OUTCOME MEASURE: The changes of patients' adherence and comprehension scores and their preferences.
RESULTS: Within-group comparisons demonstrated an increase of total adherence scores after 4 weeks in all three groups (mean changes 0.35, 0.58 and 0.67; p = 0.029, 0.013 and 0.011, respectively). The repeatedly measured total comprehension score of pictogram-incorporated label group was significantly higher than baseline (mean change 0.37, p = 0.010). Two intervention groups obtained significantly higher scores for few items in both adherence and comprehension measurements after 4 weeks as compared with baselines. As indicated by F tests, three groups did not significantly differ in the changes of both total adherence and comprehension scores (p = 0.573 and 0.069, respectively) with the subjects' age adjusted. Elderlies and those with a higher number of morbidity preferred pictogram-incorporated label over font-enlarged label.
CONCLUSION: We did not find a significant change of both adherence and comprehension levels after the introduction of modified medication labels. However, on the basis of within-group comparisons, they may have positive influences on certain aspects of patients' adherence and comprehension. Variations in preferences may reflect the unique need of different subgroups in receiving written medication instructions.
Study site: Outpatient pharmacy, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext A pilot randomized control cross over study evaluating the effectiveness and safety of mechanical percussor compared with conventional chest physiotherapy in adults with productive cough

Punithavathi N, Ong LM, Irfhan Ali HA, Mohd Izmi IA, Dharminy T, Ang AH, et al.

Med J Malaysia, 2014 Feb;69(1):16-20.
PMID: 24814623 MyJurnal

INTRODUCTION: Conventional Chest Physiotherapy (CCPT) remains the mainstay of treatment for sputum mobilization in patients with productive cough such as bronchiectasis and "Chronic Obstructive Airway Disease" (COPD). However CCPT is time consuming requires the assistance of a physiotherapist and limits the independence of the patient. Mechanical percussors which are electrical devices used to provide percussion to the external chest wall might provide autonomy and greater compliance. We compared safety and efficacy of a mechanical chest percusser devised by Formedic Technology with conventional chest percussion.
METHODS: Twenty patients (mean age 64years) were randomly assigned to receive either CCPT or mechanical percussor on the first day and crossed over by "Latin square randomisation" to alternative treatment for 6 consecutive days and the amount of sputum expectorated was compared by dry and wet weight. Adverse events and willingness to use was assessed by a home diary and a questionnaire.
RESULTS: There were 13 males and 7 females, eight diagnosed as bronchiectasis and 12 COPD. The mean dry weight of sputum induced by CCPT (0.54g ± 0.32) was significantly more compared with MP (0.40g + 0.11); p-value = 0.002. The mean wet weight of sputum with CCPT (10.71g ± 8.70) was also significantly more compared with MP (5.99g ± 4.5); p-value < 0.001. There were no significant difference in adverse events and majority of patients were willing to use the device by themselves.
CONCLUSION: The mechanical percussor although produces less sputum is well tolerated and can be a useful adjunct to CCPT.

Matched MeSH terms: Hospitals, General

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