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A randomized controlled trial of patient-controlled analgesia compared with boluses of analgesia for the control of acute traumatic pain in the emergency department

Rahman NH, DeSilva T

J Emerg Med, 2012 Dec;43(6):951-7.
PMID: 23068783 DOI: 10.1016/j.jemermed.2012.02.069

The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery.
The effectiveness of patient control analgesia in the treatment of acute traumatic pain in the emergency department: a randomized controlled trial

Rahman NH, DeSilva T

Eur J Emerg Med, 2012 Aug;19(4):241-5.
PMID: 21968714 DOI: 10.1097/MEJ.0b013e32834bfc17

Pain seems to be one of the most frequent complaints in the emergency department, however pain control is often suboptimal as seen by many audits. We conducted a study to find out whether the use of patient control analgesia (PCA) is effective in controlling acute pain in the emergency department
The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam

Rahman NH, Hashim A

Emerg Med J, 2011 Oct;28(10):861-5.
PMID: 21098799 DOI: 10.1136/emj.2009.085019

This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl.
Fulltext The display effects of patients' self-assessment on traumatic acute pain on the proportion and timing of analgesics administration in the emergency department

Rahman NH, Ananthanosamy C

Int J Emerg Med, 2014;7:36.
PMID: 25635196 DOI: 10.1186/s12245-014-0036-1

BACKGROUND: Acute pain assessment in the emergency department (ED) is important in particular during the triage process. Early pain assessment and management improve outcome. The objective of this study was to determine the effects of documentation and display of patient's self-assessment of pain using numerical rating scale (NRS) on analgesic use among adult trauma patients in ED.
METHODS: A randomized control trial was conducted recruiting 216 trauma patients who presented to ED of two tertiary centers. Pain score was done using NRS for all patients. They were randomized into pain score display group or not displayed in the control. The outcome measured were proportion of patients receiving analgesics and timing from triage to analgesic administration.
RESULTS: The proportion of patients who received analgesics when pain score was displayed was 6.5% more than when pain score was not displayed. This difference was however not statistically significant. However, stratified categorical analysis using chi-square showed that the displayed severe pain group was 1.3 times more likely to receive analgesics compared to the non-displayed group. The mean timing to analgesic administration for the displayed and non-displayed groups were 81.3 ± 41.2 (95% C.I 65.9, 96.7) and 88.7 ± 45.4 (95% C.I 69.0, 108.3), respectively (p > 0.05).
CONCLUSIONS: The proportion of patients who received analgesics increased when NRS was displayed. However, the pain display has no significant effect on the timing of analgesics.
KEYWORDS: Acute pain; Analgesic; Pain score; Triage
Fulltext The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department

Kheng CP, Rahman NH

Int J Emerg Med, 2012;5(1):31.
PMID: 22828152 DOI: 10.1186/1865-1380-5-31

BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED.
METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded.
RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival.
CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
Study site: Emergency department, Hospital Universiti Sains Malaysia
Fulltext The pattern of death related to trauma cases presented to the emergency department of a tertiary university hospital

Nik Ab Rahman NH, Mohd Hussain H

Med J Malaysia, 2013 Apr;68(2):148-52.
PMID: 23629562 MyJurnal

Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.
Fulltext Extraction and Characterization of Cellulose Nanocrystals from Tea Leaf Waste Fibers

Abdul Rahman NH, Chieng BW, Ibrahim NA, Abdul Rahman N

Polymers (Basel), 2017 Nov 07;9(11).
PMID: 30965890 DOI: 10.3390/polym9110588

The aim was to explore the utilization of tea leaf waste fibers (TLWF) as a source for the production of cellulose nanocrystals (CNC). TLWF was first treated with alkaline, followed by bleaching before being hydrolyzed with concentrated sulfuric acid. The materials attained after each step of chemical treatments were characterized and their chemical compositions were studied. The structure analysis was examined by Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD). From FTIR analysis, two peaks at 1716 and 1207 cm-1-which represent C=O stretching and C⁻O stretching, respectively-disappeared in the spectra after the alkaline and bleaching treatments indicated that hemicellulose and lignin were almost entirely discarded from the fiber. The surface morphology of TLWF before and after chemical treatments was investigated by scanning electron microscopy (SEM) while the dimension of CNC was determined by transmission electron microscopy (TEM). The extraction of CNC increased the surface roughness and the crystallinity index of fiber from 41.5% to 83.1%. Morphological characterization from TEM revealed the appearance of needle-like shaped CNCs with average diameter of 7.97 nm. The promising results from all the analyses justify TLWF as a principal source of natural materials which can produce CNC.
Geospatial and clinical analyses on pediatric related road traffic injury in Malaysia

Rahman NH, Rainis R, Noor SH, Syed Mohamad SM

World J Emerg Med, 2016;7(3):213-20.
PMID: 27547282 DOI: 10.5847/wjem.j.1920-8642.2016.03.009

BACKGROUND: The main aim of this study is to utilize the geographical information system (GIS) software and perform the spatial analysis in relation to clinical data for road traffic injury (RTI) pediatric cases attending the emergency department.
METHODS: The study sample included pediatric patients (age less than 18 years) with road-related injuries within a district in Malaysia who attended emergency departments of two tertiary hospitals within the district. In addition to injury, pre-hospital care and outcome data, the coordinate of the locations were obtained by the ambulance paramedics by using portable handheld GPS unit brand Garmin(®) model GPS 72 H. The data was transferred into the excel format which in turn underwent GIS analysis by using ARCGIS(®) (by ESRI) software version 10.1 licensed to the study institution.
RESULTS: A total of 102 (24.8%) of all motor vehicle crash (MVC) victims involved the pediatric age group (age 18 years and below). The mean (SD) age of the pediatric victims was 14.30 years (SD 3.830). Male comprised of 68 (66.7%) of the cases. Motorcyclists [88 (88.0%)] were the most common type of victims involved. Interestingly, the majority of the severely injured victims [75 (73%)] sustained the RTI on roads with maximum speed limit of 60 km/hour. The mean (SD) length of hospital stay was 7.83 days (5.59).
CONCLUSION: The pediatric related road traffic injury in Malaysia causes significant health and social burden in the country. This study showed both important clinical and geographical factors that need to be taken into consideration for future preventive action.
KEYWORDS: Geographical information system; Geospatial; Injury; Pediatric; Road safety
Fulltext Analysis on the Effects of the Human Body on the Performance of Electro-Textile Antennas for Wearable Monitoring and Tracking Application

Abd Rahman NH, Yamada Y, Amin Nordin MS

Materials (Basel), 2019 May 19;12(10).
PMID: 31109128 DOI: 10.3390/ma12101636

Previous works have shown that wearable antennas can operate ideally in free space; however, degradation in performance, specifically in terms of frequency shifts and efficiency was observed when an antenna structure was in close proximity to the human body. These issues have been highlighted many times yet, systematic and numerical analysis on how the dielectric characteristics may affect the technical behavior of the antenna has not been discussed in detail. In this paper, a wearable antenna, developed from a new electro-textile material has been designed, and the step-by-step manufacturing process is presented. Through analysis of the frequency detuning effect, the on-body behavior of the antenna is evaluated by focusing on quantifying the changes of its input impedance and near-field distribution caused by the presence of lossy dielectric material. When the antenna is attached to the top of the body fat phantom, there is an increase of 17% in impedance, followed by 19% for the muscle phantom and 20% for the blood phantom. These phenomena correlate with the electric field intensities (V/m) observed closely at the antenna through various layers of mediums (z-axis) and along antenna edges (y-axis), which have shown significant increments of 29.7% in fat, 35.3% in muscle and 36.1% in blood as compared to free space. This scenario has consequently shown that a significant amount of energy is absorbed in the phantoms instead of radiated to the air which has caused a substantial drop in efficiency and gain. Performance verification is also demonstrated by using a fabricated human muscle phantom, with a dielectric constant of 48, loss tangent of 0.29 and conductivity of 1.22 S/m.
Fulltext Critical Device Reliability Assessment in Healthcare Services

Abd Rahman NH, Ibrahim AK, Hasikin K, Abd Razak NA

J Healthc Eng, 2023;2023:3136511.
PMID: 36860328 DOI: 10.1155/2023/3136511

Medical device reliability is the ability of medical devices to endure functioning and is indispensable to ensure service delivery to patients. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) technique was employed in May 2021 to evaluate existing reporting guidelines on medical device reliability. The systematic searching is conducted in eight different databases, including Web of Science, Science Direct, Scopus, IEEE Explorer, Emerald, MEDLINE Complete, Dimensions, and Springer Link, with 36 articles shortlisted from the year 2010 to May 2021. This study aims to epitomize existing literature on medical device reliability, scrutinize existing literature outcomes, investigate parameters affecting medical device reliability, and determine the scientific research gaps. The result of the systematic review listed three main topics on medical device reliability: risk management, performance prediction using Artificial Intelligence or machine learning, and management system. The medical device reliability assessment challenges are inadequate maintenance cost data, determining significant input parameter selection, difficulties accessing healthcare facilities, and limited age in service. Medical device systems are interconnected and interoperating, which increases complexity in assessing their reliability. To the best of our knowledge, although machine learning has become popular in predicting medical device performance, the existing models are only applicable to selected devices such as infant incubators, syringe pumps, and defibrillators. Despite the importance of medical device reliability assessment, there is no explicit protocol and predictive model to anticipate the situation. The problem worsens with the unavailability of a comprehensive assessment strategy for critical medical devices. Therefore, this study reviews the current state of critical device reliability in healthcare facilities. The present knowledge can be improved by adding new scientific data emphasis on critical medical devices used in healthcare services.
Fulltext Non-Mixture Cure Model Estimation in Bladder Cancer Patients: A Novel Approach with Exponentiated Weibull Exponential Distribution

Omer ME, Mustafa M, Ali N, Abd Rahman NH

Asian Pac J Cancer Prev, 2023 Dec 01;24(12):4167-4177.
PMID: 38156852 DOI: 10.31557/APJCP.2023.24.12.4167

OBJECTIVE: Cure models are frequently used in survival analysis to account for a cured fraction in the data. When there is a cure rate present, researchers often prefer cure models over parametric models to analyse the survival data. These models enable the ability to define the probability distribution of survival durations for patients who are at risk. Various distributions can be considered for the survival times, such as Exponentiated Weibull Exponential (EWE), Exponential Exponential (EE), Weibull and lognormal distribution. The objective of this research is to choose the most appropriate distribution that accurately represents the survival times of patients who have not been cured. This will be accomplished by comparing various non-mixture cure models that are based on the EWE distribution with its sub-distributions, and distributions distinct from those belonging to the EWE distribution family.
MATERIAL AND METHODS: A sample of 85 patients diagnosed with superficial bladder tumours was selected to be used in fitting the non-mixture cure model. In order to estimate the parameters of the suggested model, which takes into account the presence of a cure rate, censored data, and covariates, we utilized the maximum likelihood estimation technique using R software version 3.5.7.
RESULT: Upon conducting a comparison of various parametric models fitted to the data, both with and without considering the cure fraction and without incorporating any predictors, the EE distribution yields the lowest AIC, BIC, and HQIC values among all the distributions considered in this study, (1191.921/1198.502, 1201.692/1203.387, 1195.851/1200.467). Furthermore, when considering a non-mixture cure model utilizing the EE distribution along with covariates, an estimated ratio was obtained between the probabilities of being cured for placebo and thiotepa groups (and its 95% confidence intervals) were 0.76130 (0.13914, 6.81863).
CONCLUSION: The findings of this study indicate that EE distribution is the optimal selection for determining the duration of survival in individuals diagnosed with bladder cancer.
Fulltext A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia

Chew KS, Khor HW, Ahmad R, Rahman NH

Int J Emerg Med, 2011;4:41.
PMID: 21752254 DOI: 10.1186/1865-1380-4-41

Although the majority of the snakebite cases in Malaysia are due to non-venomous snakes, venomous bites cause significant morbidity and mortality if treatment measures, especially ant-venom therapy, are delayed.
Fulltext Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1

Rahman NH, Ahmad R, Kareem MM, Mohammed MI

Int J Emerg Med, 2016 Dec;9(1):8.
PMID: 26894896 DOI: 10.1186/s12245-016-0101-z

We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%.ᅟ
Fulltext Burden of motorcycle-related injury in Malaysia

Rahman NH, Baharuddin KA, Mohamad SM

Int J Emerg Med, 2015;8:17.
PMID: 26085844 DOI: 10.1186/s12245-015-0065-4

Road traffic injury (RTI) contributes to major morbidity and mortality in both developed and developing countries. Most of the injuries are caused by road-related injuries that specifically relate to motorcycle crash. We attempted to conduct a short survey to determine the magnitude of burden related to motorcycle-related RTIs in Malaysia. We hypothesize that motorcycle-related RTI in Malaysia contributes significantly to the health burden in the country.
The use of end-tidal capnography to monitor non-intubated patients presenting with acute exacerbation of asthma in the emergency department

Howe TA, Jaalam K, Ahmad R, Sheng CK, Nik Ab Rahman NH

J Emerg Med, 2011 Dec;41(6):581-9.
PMID: 19272745 DOI: 10.1016/j.jemermed.2008.10.017

STUDY OBJECTIVE: To determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computer-recognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED).
METHODS: In this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired-samples t-test analysis.
RESULTS: On the capnographic waveform pre- and post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p = 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices.
CONCLUSION: The study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring non-intubated asthmatics in the ED.
Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
The use of an In House Scoring System Scale versus Glasgow Coma Scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries?

Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J

Southeast Asian J. Trop. Med. Public Health, 2007 Nov;38(6):1126-40.
PMID: 18613557

Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.
Alocasia denudata Engler treatment enhance open wound healing activities in Wistar rat's skin

Latif MA, Zaki MZ, Leng TM, Rahman NH, Arshad SA, Hamid A

J Ethnopharmacol, 2015 Dec 24;176:258-67.
PMID: 26519202 DOI: 10.1016/j.jep.2015.10.036

A. denudata is traditionally used to treat various skin disorders, including wounds. It is widely used by the traditional healers as an effective wound treatment.
Immobilization of recombinant Escherichia coli on multi-walled carbon nanotubes for xylitol production

Abd Rahman NH, Md Jahim J, Abdul Munaim MS, A Rahman R, Fuzi SFZ, Md Illias R

Enzyme Microb Technol, 2020 Apr;135:109495.
PMID: 32146929 DOI: 10.1016/j.enzmictec.2019.109495

E. coli has been engineered to produce xylitol, but the production faces bottlenecks in terms of production yield and cell viability. In this study, recombinant E. coli (rE. coli) was immobilized on untreated and treated multiwalled carbon nanotubes (MWCNTs) for xylitol production. The immobilized rE. coli on untreated MWCNTs gave the highest xylitol production (5.47 g L-1) and a productivity of 0.22 g L-1 h-1. The doubling time for the immobilized cells increased up to 20.40 h and was higher than that of free cells (3.67 h). Cell lysis of the immobilized cells was reduced by up to 73 %, and plasmid stability improved by up to 17 % compared to those of free cells. Xylitol production using the optimum parameters (pH 7.4, 0.005 mM and 29 °C) achieved a xylitol production and productivity of 6.33 g L-1 and 0.26 g L-1 h-1, respectively. A seven-cycle repeated batch fermentation was carried out for up to 168 h, which showed maximum xylitol production of 7.36 g L-1 during the third cycle. Hence, this new adsorption immobilization system using MWCNTs is an alternative to improve the production of xylitol.
Fulltext Protocol for a mixed-method systematic review on challenges perceived by final-year undergraduate nursing students in a clinical learning environment

Ali SH, Ahmad Rahman NH, Mohd Shariff N, Karim J, Chin KY

J Adv Nurs, 2021 Sep;77(9):3933-3939.
PMID: 34028853 DOI: 10.1111/jan.14880

AIMS: To determine the challenges perceived by final-year nursing students in the clinical learning environment.
DESIGN: Data-based convergent mixed-method systematic review.
METHODS: Three electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full-text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed-method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020.
DISCUSSION: This study will synthesize the types of challenges perceived by final-year undergraduate nursing students in different clinical learning environments across the country.
IMPACT: The proposed study findings will help nursing education stakeholders and faculty provide assistance to final-year nursing students in their transition year to become registered nurses.
An Evidence-based Forensic Taxonomy of Windows Phone Dating Apps

Cahyani NDW, Choo KR, Ab Rahman NH, Ashman H

J Forensic Sci, 2019 Jan;64(1):243-253.
PMID: 29783278 DOI: 10.1111/1556-4029.13820

Advances in technologies including development of smartphone features have contributed to the growth of mobile applications, including dating apps. However, online dating services can be misused. To support law enforcement investigations, a forensic taxonomy that provides a systematic classification of forensic artifacts from Windows Phone 8 (WP8) dating apps is presented in this study. The taxonomy has three categories, namely: Apps Categories, Artifacts Categories, and Data Partition Categories. This taxonomy is built based on the findings from a case study of 28 mobile dating apps, using mobile forensic tools. The dating app taxonomy can be used to inform future studies of dating and related apps, such as those from Android and iOS platforms.

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