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Self-perceived disease control in childhood eczema

Lam PH, Hon KL, Leung K, Leong KF, Li CK, Leung TF

J Dermatolog Treat, 2020 Sep 22.
PMID: 32962454 DOI: 10.1080/09546634.2020.1826395

BACKGROUND: Atopic eczema (AE) is a common relapsing inflammatory skin disease in children which is often associated with chronicity and poor quality of life. Unlike atopic asthma, control of AE is seldom assessed in therapeutics.
AIM: To investigate the utility of a Traffic Light Control (TLC) system as a measurement/assessment of self-perceived eczema control.
METHODS: This is a prospectively study of all Chinese children (aged 6 to 18 years old) with eczema attending the paediatric dermatology clinic of a tertiary hospital from Jan to June 2020. Eczema control, eczema severity, quality of life and biophysical skin condition of consecutive patients at the paediatric dermatology clinic of a teaching hospital were evaluated with the validated Chinese versions of Depressive, Anxiety, Stress Scales (DASS-21), Patient Oriented Eczema Measure (POEM), transepidermal water loss (TEWL), and stratum corneum skin hydration (SH), respectively. With a visual TLC analogy, patients were asked if their eczema is under control (green light), worsening (yellow) or in flare-up (red light).
RESULTS: Among AE patients (n = 36), self-perceived TLC as green (under control), amber (worsening) and red (flare up) reflected acute and chronic severity (SCORAD, NESS, POEM) and quality of life (CDLQI) (p< 0.0001), but not SH, TEWL or Depression, anxiety and stress.
CONCLUSIONS: Eczema control can be semi-quantified with a child-friendly TLC self-assessment system. AE patients reporting worse eczema control have worse acute and chronic eczema severity, more impairment of quality of life; but not the psychologic symptoms of depression, anxiety and stress or skin hydration or transepidermal water loss. TLC can be linked to an eczema action plan to guide patient management.

Matched MeSH terms: Hospitals, Teaching
Fulltext Implementation of a COVID-19 surveillance programme for healthcare workers in a teaching hospital in an upper-middle-income country

Wan KS, Tok PSK, Yoga Ratnam KK, Aziz N, Isahak M, Ahmad Zaki R, et al.

PLoS One, 2021;16(4):e0249394.
PMID: 33852588 DOI: 10.1371/journal.pone.0249394

INTRODUCTION: The reporting of Coronavirus Disease 19 (COVID-19) mortality among healthcare workers highlights their vulnerability in managing the COVID-19 pandemic. Some low- and middle-income countries have highlighted the challenges with COVID-19 testing, such as inadequate capacity, untrained laboratory personnel, and inadequate funding. This article describes the components and implementation of a healthcare worker surveillance programme in a designated COVID-19 teaching hospital in Malaysia. In addition, the distribution and characteristics of healthcare workers placed under surveillance are described.
MATERIAL AND METHODS: A COVID-19 healthcare worker surveillance programme was implemented in University Malaya Medical Centre. The programme involved four teams: contact tracing, risk assessment, surveillance and outbreak investigation. Daily symptom surveillance was conducted over fourteen days for healthcare workers who were assessed to have low-, moderate- and high-risk of contracting COVID-19. A cross-sectional analysis was conducted for data collected over 24 weeks, from the 6th of March 2020 to the 20th of August 2020.
RESULTS: A total of 1,174 healthcare workers were placed under surveillance. The majority were females (71.6%), aged between 25 and 34 years old (64.7%), were nursing staff (46.9%) and had no comorbidities (88.8%). A total of 70.9% were categorised as low-risk, 25.7% were moderate-risk, and 3.4% were at high risk of contracting COVID-19. One-third (35.2%) were symptomatic, with the sore throat (23.6%), cough (19.8%) and fever (5.0%) being the most commonly reported symptoms. A total of 17 healthcare workers tested positive for COVID-19, with a prevalence of 0.3% among all the healthcare workers. Risk category and presence of symptoms were associated with a positive COVID-19 test (p<0.001). Fever (p<0.001), cough (p = 0.003), shortness of breath (p = 0.015) and sore throat (p = 0.002) were associated with case positivity.
CONCLUSION: COVID-19 symptom surveillance and risk-based assessment have merits to be included in a healthcare worker surveillance programme to safeguard the health of the workforce.

Matched MeSH terms: Hospitals, Teaching
Fulltext Socio-demographic and physical factors associated with disability in adults with non- specific chronic neck pain

Ponvel, P., Devinder K.A. Singh, Yan Hang, M., Muniandy Y., Mokhtar, S.

Medicine & Health, 2018;13(2):122-132.
MyJurnal

While socio-demographic, physical and other factors are associated with neck pain, there is scanty literature about how these factors are associated with disability in adults suffering from this condition. We aimed to determine the socio-demographic and physical (strength and range of motions) related factors of disability in adults with non-specific chronic neck pain. A total of 34 adults with neck pain, with mean age 55 (10.80) years from a physiotherapy clinic in a teaching hospital participated in this study. Socio-demographic details such as body mass index (BMI), current employment status, hours of exercise done a week were obtained. Severity of pain was evaluated using the Numerical Rating Scale (NRS). Disability level was assessed using Neck Disability Index. Cervical range of motion was measured using the Cervical Range of Motion device. A hand dynamometer was used to measure the dominant hand grip muscle strength. The data was analyzed using descriptive and stepwise linear regression analysis. More than half the participants were females, above 50 years, in the overweight group (BMI>25 kg/m2), currently unemployed and had severe neck pain (NRS >7). Handgrip strength was the only factor found to be significantly (p

Matched MeSH terms: Hospitals, Teaching
Fulltext Assessment of clinical, risk factors profile and clinical pharmacist care services on management and prevention of coronary artery disease complications among diabetic patients in a tertiary care hospital practice

Abbavannagari Bharath Kumar, Marakanam Srinivasan Umashankar, Sandeep Podda

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):21-28.
MyJurnal

Introduction: Diabetes is a chronic metabolic disease and noted to be incidence is intensifying globally and contem- plated as epidemic. The study is aimed to assess the coronary artery disease risk profile associated diabetes mellitus patient and to identify the clinical pharmacist care services in the management and to control the risk burden in the clinical practice. Method: A prospective observational study was conducted among the consecutive patients of coronary artery disease associated diabetic patients in a tertiary care teaching hospital over 6 months period. A sam- ple of 150 patients was recruited in the study. Data analysis was done with graph pad prism software 5.01. Results: The present study revealed that coronary artery disease in diabetes was more prevalent in age group between 41-50 years. About 54.66% patients with hyperlipidemia were at risk to develop the coronary artery disease complication. Glycated hemoglobin test was detected in 40% of the patient showing abnormal levels and around 43.33% of patient had an abnormal fasting blood sugar level. The study showed only 32% of patients was prescribed Insulin & oral hy- poglycemic agents and 13 % were treated with statins. Conclusion: It could be concluded that the causative factors should be controlled and treated with an early need for amalgamation of clinical pharmacist care services with the health care team on life style modification counseling could ultimately improve the patient health outcomes and also lowers progression of coronary artery disease risk complications among diabetic patients.

Matched MeSH terms: Hospitals, Teaching
Fulltext Factors associated with poor perceptions of graphic warning signs (GWS) on cigarette package among adult smokers in Kelantan

Afiq Izzudin A Rahim, Mohd Ismail Ibrahim

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):132-139.
MyJurnal

Introduction: Initially, studies showed that graphic warning signs (GWSs) on cigarette packages encouraged smok- ing cessation. However, there have been recent concerns over the effectiveness of GWSs to change smoker percep- tions and behavior over time. Our goals were to assess the latest perceptions of GWSs among smokers in Kelantan and to determine the factors associated with them. Methods: This cross-sectional study was conducted among re- spondents who attended outpatient clinics in a teaching hospital in Kelantan. Their perceptions were analyzed with a validated Malay questionnaire containing four domains: fear, influence, credibility, and picture content. Results: The average smoking age was 17 (3.04) years old. The mean smoking time was 11 (7.49) years. The average daily cigarettes smoked was 8 (6.26). Most respondents perceived low levels of fear (83%), poor picture content (65.5%), low influence (87.6%), and low levels of credibility (70.1%) in GWSs. Those with low levels of education were significantly associated with poor perceptions of GWSs. Conclusion: Despite vigorous efforts by the government to discourage smoking in Kelantan, smokers still poorly perceive GWSs. More effective health-promotion strategies are essential to influence smokers in this area.

Matched MeSH terms: Hospitals, Teaching
Fulltext Inculcating collaborative practice among healthcare professionals: initiative from Hospital Universiti Malaysia Sabah

Jeanny John, Joanne Justin, Dainah Francis, Helen Benedict Lasimbang, Wendy Diana Shoesmith, Loo Jiann Lin, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):8-0.
MyJurnal

Introduction: Collaborative working culture is an important milestone to be inculcated in a hospital setting. In the process of preparation for the upcoming teaching hospital of Universiti Malaysia Sabah (HUMS), the organisational value of innovative, collaborative, compassionate, empowering, and sustainable needs to be inculcated to the both management and clinical staffs. The objective of this study was to assess the efficacy of a collaborative practise workshop in staff. Methods: A two days experiential learning workshop was conducted to deliver and inculcate the organisational value of HUMS to 32 existing and newly recruited healthcare professionals, which include doctor, nurses, assistant medical officer, dental assistant, pharmacist, and radiographer. The topics consisted of principles of collaborative practice, skill of validation, feedback-giving method, approach for value identification and goal setting, reflective practice, public communication during crisis, shared decision making, and organisational problem solving. Different delivery methods include round table discussion, role play, and group work were used. Innovative real time practice of giving feedback to the management was performed directly to the hospital chief executive officer and chief clinical officer. Results: Immediate feedback from the participants found that the candidates found the course was enriching and it helped them to develop an alternative perspective on how to get work done. The staffs expressed their idea, concern, and expectation more openly with the method learned using what they had learnt. The limitation included the challenge of transition from previous working culture to new environment without further supervision. Conclusions: Further systematic evaluation using more detailed assessment tool is needed to understand the long term efficiency and translatability of the learning outcomes into clinical practice once the hospital is ready.

Matched MeSH terms: Hospitals, Teaching
Fulltext Dietetic practices in the management of childhood obesity in Malaysia

Nor Baizura, M.Y., Ting, T.H., Zalilah, M.S., Ruzita, A.T., Spurrier, N.

Malays J Nutr, 2014;20(2):255-269.
MyJurnal

Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia.
Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians.
Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level.
Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.

Matched MeSH terms: Hospitals, Teaching
Fulltext Back to basic: bio-burden on hands of health care personnel in tertiary teaching hospital in Malaysia

Wong JL, Siti Azrin AH, Narizan MI, Norliah Y, Noraida M, Amanina A, et al.

Trop Biomed, 2014 Sep;31(3):534-9.
PMID: 25382481 MyJurnal

Hands of Health Care Personnel (HCP) are one of the most common vehicles for the transmission of infection. Microorganisms can survive well on the hands of HCP for a certain duration. Therefore, the purpose of this study is to bring awareness to HCP that their hands can actually be contaminated with many microorganisms. These microbes on the hands of HCP can potentially infect their patients if they do not comply with the proper hand hygiene practice. This cross-sectional study was conducted at a randomly selected Intensive Care Unit (ICU) and general ward in a hospital. Twenty five HCP from each ward were randomly selected and their hands were imprinted on blood culture plates. Microorganism growth were quantified and identified. Data were analyzed and presented as descriptive analysis. One hundred blood agar plates were processed and analyzed. Majority (71%) of the samples had more than 50 colony-forming units (CFU) and only 17% of the samples had less than 25 CFU. Microorganisms identified include Staphylococcus spp., Acinetobacter spp., Enterobacteriaceae, Pseudomonas spp., Moraxella, Delftiaacidovorans and fungi. All isolated microorganisms were antibiotic sensitive strain. This study showed that the hands of HCP were contaminated with many microorganisms. Therefore, it is imperative that HCP must practice proper hand hygiene when taking care of their patients in the wards.

Matched MeSH terms: Hospitals, Teaching
Fulltext The integron prevalence of extended-spectrum beta-lactamase producing enterobacterial isolates in a Malaysian teaching hospital

Ibrahim N, Wajidi MF, Yusof MY, Tay ST

Trop Biomed, 2011 Dec;28(3):668-71.
PMID: 22433898 MyJurnal

The increased frequency of antibiotic resistance is known to be associated with the dissemination of integrons in the Enterobacteriaceae. This study determined the prevalence and type of integrons amongst 160 extended-spectrum beta-lactamase producing enterobacterial isolates kept in our culture collection. Integrons were detected in 98(61.3%) isolates, including 28(62.2%) Escherichia coli, 34(64.2%) Klebsiella spp., 27(61.4%), Enterobacter spp. and 9(50.0%) Citrobacter spp. investigated in this study. Restriction analysis of the integron gene fragments revealed that class I integron was the principal integron detected in 92(57.5%) of our isolates. Class II integron was detected in 6(3.8%) of our isolates, while no class III integron was detected in this study. The high rates of integron prevalence particularly of the class I integron in the E. coli and Klebsiella spp. concur with previous studies in other geographical regions. The higher (≥50%) integron prevalence of Citrobacter and Enterobacter isolates comparing to previous studies suggests the potential of these isolates as sources for dissemination of resistance determinants. The finding in this study serves as a basis for further study on the antibiotic resistance mechanisms of enterobacterial species in this teaching hospital.

Matched MeSH terms: Hospitals, Teaching
Intestinal parasitic infections frequency in referred patients to a large teaching hospital, Khuzestan, Southwest, Iran, 2017

Feiz Haddad MH, Maraghi S, Ali SA, Feiz Haddad R, Nasser Zadeh R

Trop Biomed, 2018 Dec 01;35(4):915-925.
PMID: 33601841

Intestinal parasitic infections (IPIs) are among the most important infectious diseases in Iran. A cross sectional study was designed to determine frequency of intestinal parasites among referrals to a large teaching hospital in Khuzestan, Southwest of Iran, 2017. A total number of 5613 stool samples were examined through direct smear and formalin-ether concentration methods to detect possible parasitic infections. Samples consisted of 2643 (47.09%) male and 2970 (52.91%) female. A total of 1468 (26.15%) samples were positive (13.11% male and 13.4% female) and 4145 (73.85%) were negative. The results also showed that 255 of samples had more than one type of parasite (mix infections). Counting single and mix parasite infections, the total number of positive cases reached to 1723. Helminthes parasites were present in 12 (0.7%) cases, while intestinal protozoan parasites were in 1711 (99.3%) cases. Almost equally, pathogenic and nonpathogenic parasites infected 860 (49.91%) and 863 (50.09%) of patients, respectively. The frequency for helminthes was determined at 0.52% with Hymenolepis nana and Enterobius vermicularis however, Giardia lamblia in 38.54% and Entamoeba histolytica/dispar at 10.68% were concluded as protozoa elements. The IPIs frequency was recorded in female and male patients at 49.16% and 50.14%, respectively. According to the current results the infection rate of intestinal parasites has been significantly reduced especially for helminths infections in this region possibly due to public attention to health issues such as; increased awareness of people, improvement of sanitation, seasonal variations, health education and personal hygiene.

Matched MeSH terms: Hospitals, Teaching
Phenotypic evaluation of ESBL- and carbapenemaseproducing Escherichia coli and Klebsiella pneumoniae from a teaching hospital in the Philippines

Tiongco RE, Arceo E, Dizon D, Navarro A, Rivera N, Salita C, et al.

Trop Biomed, 2018 Dec 01;35(4):1064-1074.
PMID: 33601853

Antimicrobial resistance is a worldwide public health concern. Rise in the number of antimicrobial resistant organisms, such as extended spectrum β-lactamase- (ESBL) and carbapenemase-producing Escherichia coli and Klebsiella pneumoniae, continue to burden millions of people worldwide. E. coli and K. pneumoniae were isolated and collected for four months from a teaching hospital in the Philippines. All isolates were subjected to ESBL and carbapenemase testing using the double disk synergy test and modified Hodge test, respectively. Their pattern of resistance among different classes of antimicrobial agents was also investigated using the Kirby-Bauer disk diffusion test. Among the 32 clinical isolates tested, 28.1% were positive for ESBL production and 6.3% were positive for carbapenemase production. Species-specific classification showed that E. coli (44.4%) has the highest rate of ESBL production whereas both E. coli (5.6%) and K. pneumoniae (7.1%) showed almost similar rates of carbapenemase production. Antimicrobial resistance pattern of drug resistant isolates showed that all organisms were resistant to ampicillin, and majority showed resistance towards ciprofloxacin, cefotaxime, ceftriaxone, and sulfamethoxazole/trimethoprim. ESBL production is seen highest among E. coli isolates while similar rates of carbapenemase production was observed to both E. coli and K. pneumoniae isolates. Overall, antimicrobial resistance continues to rise and poses a huge threat in public health worldwide. Efforts should be made in developing rapid tests for antimicrobial resistance and to search for effective treatment from infections caused by multidrug resistant organisms.

Matched MeSH terms: Hospitals, Teaching
Accuracy of intraoperative consultation for ovarian tumours: Experience in an Indonesian teaching hospital

Fauziah D, Anggoro R R

Malays J Pathol, 2020 Dec;42(3):409-414.
PMID: 33361722

BACKGROUND: Ovarian tumours are a very heterogeneous group of tumours, consisted of non-neoplastic and neoplastic lesions. Preoperative diagnoses in most conditions are inconclusive due to similar clinical, radiological and laboratory findings. Intraoperative consultation is crucial because it can provide rapid diagnosis leading to a suitable surgical management for the patients.
OBJECTIVE: To obtain profile, accuracy and concordance rates of ovarian intraoperative consultation in Dr. Soetomo Hospital Surabaya, a teaching hospital in Indonesia.
MATERIALS AND METHODS: Observational retrospective study, using data from archives of intraoperative consultation reports in Dr. Soetomo General Hospital Surabaya within 2012-2016 period. There were 734 cases of ovarian intraoperative consultations, all then proceed to permanent sections. Accuracy, sensitivity, and specificity rates were calculated.
RESULTS: Overall accuracy was 89.5%. Sensitivity for benign, borderline and malignant cases were 98.49%, 71.19% and 84.01%, respectively. Specificity were 90.32%, 95.11% and 98.72%, respectively.
CONCLUSION: Intraoperative consultation for ovarian tumours has a reliable diagnostic value in benign and malignant lesion, but lower value in borderline tumours.

Matched MeSH terms: Hospitals, Teaching
Fulltext Exploring burnout among Malaysian junior doctors using the abbreviated Maslach Burnout Inventory

Zuraida Ahmad Sabki, Zainal NZ

Malaysian Journal of Psychiatry, 2015;24(1):23-32.
MyJurnal

Objective: The study aimed to explore the prevalence of burnout among the junior doctors and to examine the psychometric properties of abbreviated Maslach Burnout Inventory (aMBI). Methods: A cross-sectional study was conducted using aMBI self-reported questionnaire and Hospital Anxiety Depression Scale which was carried out on a sample of 117 junior doctors working in a teaching hospital in Malaysia. Results: Exploratory factor analysis of aMBI revealed a three-factor structure labelled as emotional exhaustion, depersonalization and personal accomplishment with Crohnbach’s alpha of 0.85, 0.59 and 0.64 respectively. The total variance was 67%. Prevalence of burnout was found at 26.5%. Emotional exhaustion and depersonalization were positively correlated with depression and anxiety. Shorter duration of residence (less than six months) and being posted to Trauma & Emergency unit were associated with higher mean score of burnout. Conclusion: This study provides the knowledge of level of burnout among the junior doctors and the abbreviated Maslach Burnout Inventory has a satisfied psychometirc properties for screening burnout among junior doctors in Malaysia.

Matched MeSH terms: Hospitals, Teaching
Fulltext Assessing the service quality of physiotherapy services: a cross sectional study at teaching hospitals in Klang Valley, Malaysia

Nasaruddin Mahdzir, M., Aniza, I., Nor Faridah, A.R., Sulha, A.

Malaysian Journal of Public Health Medicine, 2013;13(2):27-37.
MyJurnal

The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.
Study site: Physiotherapy department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and University Malaya Medical Centre (UMMC)

Matched MeSH terms: Hospitals, Teaching
Fulltext Pilot study on the effect of yasiin recitation on the haemodynamics of ventilated patients

Ariff, M.S., Mai Ashikin, N.T., Maryamjameelah, R., Bushra, J., Wan Azman, W.A.

International Medical Journal Malaysia, 2013;12(2):45-49.
MyJurnal

Qur’anic verses recitations to ill patients are practiced by many Muslims as a form of healing and worship. The effectiveness has been observed in many medical institutions; however, it has never been objectively measured and documented. This pilot study was conducted to construct a methodological approach to evaluate the therapeutic effects of Yasiin recitation on the haemodynamics of critically ill patients. Methods: Ventilated Muslim patients in coronary care unit of a teaching hospital were evaluated. Yasiin was recited twice; by one of the researchers and then by the patients’ relatives. Mean arterial blood pressure, pulse rate, oxygen saturation level and electrocardiographic changes, were observed. The difference of the parameters before and during recitation was analysed. Results: Five patients fulfilling the selection criteria were selected; two acute myocardial infarctions, two congestive cardiac failures, and a third-degree atrioventricular block. Based on a non-parametric two-related-sample test, the haemodynamic parameters were not significantly affected by Yaasiin recitation. At the end of the study, two of the patients passed away, one patient was extubated and survived. Two patients were still on ventilators when the study had been completed. Limitations in the study were observed and highlighted in explaining the equivocal results. Conclusions: The effect of Yasiin recitation on heamodynamics of patients was not proven in this study. Further refinements might be needed based upon the observation on limitations encountered. It is hoped that this humble effort would pave the way for further studies to explore this field.

Matched MeSH terms: Hospitals, Teaching
Fulltext Cross-sectional descriptive study of management modalities and quality of life of surgical patients in a palliative care unit

Amjad, N.M., Karim, K.A., Naing Soe, Y.

International Medical Journal Malaysia, 2016;15(1):35-43.
MyJurnal

Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill
and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of
malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly
palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of
surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia.
Objectives of this study are: to study the demographic characteristics and indications for admission of
surgical patients in palliative care unit, to study the options of treatment modalities and their
complications, to identify the barriers in decision making in surgical treatment and finally to objectively
assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire.
Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority
Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast
(30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers.
Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers
to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting
at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating
were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions:
Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other
fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study
shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our
aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades
of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere
words.

Matched MeSH terms: Hospitals, Teaching
Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors

Eskandari F, Abdullah KL, Zainal NZ, Wong LP

J Clin Nurs, 2017 Dec;26(23-24):4479-4488.
PMID: 28233363 DOI: 10.1111/jocn.13778

AIMS AND OBJECTIVES: To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables.
BACKGROUND: A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals.
DESIGN: A cross-sectional study was used.
METHODS: A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur.
RESULTS: Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint.
CONCLUSION: This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint.
RELEVANCE TO CLINICAL PRACTICE: Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals.

Matched MeSH terms: Hospitals, Teaching
Fulltext Factors associated with metabolic syndrome among psychiatric outpatients with major depressive disorder

Hat, H.T., Shahrul Azhar, M.H., Chong, L.L., Ee, W.S., Amirah, R., Hazli, Z., et al.

Malaysian Journal of Psychiatry, 2011;20(2):1-13.
MyJurnal

Background: Metabolic Syndrome is a major concern for the general population but more so for depressed patients. While it is well established that it is highly prevalent among patients who are depressed, none of the local studies identified the factors contributing to the syndrome.
Objective: This study aimed to determine the rate of metabolic syndrome and its associated factors (socio-demographic, clinical features and lifestyle risk factors) in depressed patients.
Methods: A cross sectional study was conducted on patients with major depressive disorders (MDD) attending psychiatric outpatient clinic in Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a teaching hospital in Kuala Lumpur. A total of 72 outpatients who fulfilled the selection criteria were informed to fast prior to blood taking. The diagnosis of MDD was made based on Diagnostic Statistical Manual Version IV (DSM-IV) while the metabolic syndrome diagnosis was made using the International Diabetes Federation (IDF) criteria based on the patients’ waist circumference, blood pressure, serum glucose level and lipid profile.
Results: The rates of metabolic syndrome was 37.5% (n = 27). The results showed significant associations between metabolic syndrome and race (p = 0.043), illness duration (p = 0.043) and pre-existing hyperlipidaemia (p = 0.032). Interestingly, lifestyle factors like physical activity (p = 0.762), dietary intake (p = 0.671), severity of depression (p = 0.161) and the different types of medications (p = 0.242 to 1.000) were not found to significantly associated with metabolic syndrome among the study sample.
Conclusions: Metabolic syndrome was found to be disproportionately high among depressed patients. Two significant factors associated with this syndrome were race and long duration of depression (ten years or more). This study suggests that early screening and identification can be beneficial to be incorporated in the management of depression in anticipation of future complications.

Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Hospitals, Teaching
Fulltext The prevalence and associated factors of psychiatric early readmission in a teaching hospital, Malaysia

Ng, C.G., Yee, H.A., Zainal, N.Z., Loh, H.S.

Malaysian Journal of Psychiatry, 2012;21(1):0-0.
MyJurnal

Objective: The aim of the study was to determine the early readmission rate among the psychiatric patients discharged from a teaching hospital in Malaysia. The associated factors were also examined. Methods: This is a prospective and observational study. The socio-demographic and clinical data of 202 patients from the psychiatric ward were collected on discharge along with the administration of instruments including Brief Psychiatric Rating Scale (BPRS), Life Events Questionnaire (LEQ), and Multidimensional Scale of Perceived Social Support (MSPSS). Assessment of compliance to medication and substance use was reliant on self-report data. Medication compliance was categorized as “poor” vs “good”, whereas poor compliance was the complete discontinuation of medication for at least two weeks. The patients were followed up to determine whether they were readmitted within 6 months. Results: At the end of 6 months follow-up, 32.2% of the subjects were readmitted. Univariate regression analysis indicated that patients with psychotic disorder, past episodes, previous admission, poor compliance, on conventional or depot injectable antipsychotic and higher BPRS scores on discharge were significantly associated with early readmission (p

Matched MeSH terms: Hospitals, Teaching
Fulltext Knowledge, attitude and practices of the risk for chronic kidney disease among patients in a tertiary teaching hospital

Dariah Mohd Yusoff, Junaiti Yusof, Kueh, Yee Cheng

The Malaysian Journal of Nursing, 2016;8(2):3-11.
MyJurnal

Patients with chronic diseases such as diabetes, hypertension and cardiovascular diseases are known as
high-risk groups for developing chronic kidney disease (CKD). Adequate related knowledge among them
helps to increase their awareness towards CKD and adapt healthy attitude and practices for CKD
prevention, which will result in better health outcomes. This study aimed to identify the patients'
knowledge, attitude, and practices (KAP) towards the risks for CKD. This cross-sectional study used a selfadministered
survey questionnaire on 103 adult male and female patients at four general surgical and
medical wards in a teaching hospital using convenient sampling method. The data were computed using
STATA version 12. Data on KAP were obtained through the Chronic Kidney Disease Screening Index
questionnaire. The majority of respondents had poor knowledge (69.9%, n=72), but most of them had good
attitude (68.9%, n=71) and good practices (88.3%, n=91) towards the risk of CKD. Significant associations
were indicated between education level, occupation and monthly family income with knowledge (p-value <
0.05). Significant associations were also indicated between age, sex, marital status and occupation with
their attitude (p-value < 0.05). Meanwhile, marital status was found to be significantly associated with the
practices towards the risk for CKD (p-value=0.008).
Poor knowledge on the risk of getting CKD among hospitalized adults in this study implied the need for
improvement in the public understanding towards the risk for CKD.

Matched MeSH terms: Hospitals, Teaching

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