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Fulltext The use of laboratory and physiological parameters in predicting mortality in sepsis induced hypotension and septic shock patients attending the emergency department

Nik Hisamuddin NAR, Azlan K

Med J Malaysia, 2012 Jun;67(3):259-64.
PMID: 23082413 MyJurnal

In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock.
Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound - A randomised trial

Nik Hisamuddin NAR, Wan Mohd Zahiruddin WN, Mohd Yazid B, Rahmah S

Med J Malaysia, 2019 Oct;74(5):418-424.
PMID: 31649219

INTRODUCTION: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management.
METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.
RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).
CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.
Fulltext Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NAR, Siti Asma H

Med J Malaysia, 2013 Aug;68(4):323-5.
PMID: 24145260 MyJurnal

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.
Determination of service key performance indicators for emergency departments of teaching hospitals in Malaysia: A fuzzy delphi method

Nik Hisamuddin NAR, Normalinda Y, Abu Yazid MN, Mimi Azliha AB, Andey R, Mohd Hashairi F, et al.

Med J Malaysia, 2021 Nov;76(6):792-798.
PMID: 34806662

INTRODUCTION: The most crucial step in forming a set of key performance indicators (KPI) for emergency department's (ED) staff is deciding the appropriate items for the KPI. This article demonstrates Fuzzy Delphi Method (FDM) as a scientific approach to consolidate consensus agreement within a panel of experts pertaining to each service related KPI item's appropriateness for ED. We aimed to develop framework of service key performance indicators for emergency departments of tertiary centres by using FDM.
MATERIALS AND METHODS: The panel consists of ten experts from ED that was randomly chosen from list of specialists obtained from the National Specialist Registry for Emergency Medicine. A set of questionnaires that contains item constructs related to KPI based on structure, outcome and process was developed from initial literature search from Pubmed Central, Google Scholar, Cochrane Database and Public Library of Sciences. The construct then used for FDM session in second phase of the study. In FDM phase, the experts will rank each of the items created from nominal group technique (NGT) session by using Likert Scale ranged from 1 to 5 ("1" totally disagree and "5" extremely agree). FDM prerequisite must include threshold value (d) ≤0.2, expert consensus of >75% and average fuzzy numbers ("A" value) of >0.5.
RESULTS: The initial item construct has produced 22 items proposed for the service KPI. Post FDM analysis for service KPI, 16 out of the 22 (72%) satisfied first prerequisite "d" value ≤0.2. For the second prerequisite, ten items (45%) from service KPI domain had expert consensus of more than 75%. For the third prerequisite, 16 out of the 22 (73%) fit the criteria of average fuzzy number ("A" value) of more than 0.5. In final model of FDM, 13 items (59%) were discarded and the remaining (n=9 items) that fulfilled all three prerequisites were retained for the final draft for content validation process.
CONCLUSION: This study introduces that FDM can be used to obtain experts' opinion and consensus in order to achieve a decision. The experts' consensus on the suitability of the pre-selected items on the KPI set were obtained, hence it is now ready for further applicability in the clinical setting in ED.