MATERIALS AND METHODS: This is a retrospective study looking at data collected during office hours on 79 working days, excluding weekends and public holidays in Hospital Melaka, Malaysia. Details on all medical access block cases that were reviewed were recorded including their locations, diagnosis, disposition decisions and if they received specialist input at the time of their initial assessment by the medical team in ED. The aim is to revolutionise patient admission flow by offering early specialist care with rapid assessment, investigation and treatment. Hence, improving the overall treatment efficiency and reduce medical access block.
RESULTS: There were 1321 admissions. A total of 82% of the patients were admitted to the medical wards while 13% of them were given acute treatment in ED and discharged home with appropriate follow ups. We managed to resolve 18% of medical access block by re-triaging our cases and offering timely acute medical treatment. Nearly 90% of patients received first hand medical specialist input during the initial assessment by the Acute Internal Medicine (AIM) team in ED.
CONCLUSION: The significant resolution in medical access block with active screening, re-triaging and management of patients by the AIM team allows a more optimal hospital bed management. Patients also receive timely access to medical intervention with specialist care and stable patients can benefit from early supported discharge.
METHODS: A meta-analysis was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ('PRISMA') checklist. The primary clinical characteristics of patients, and hazard ratios with 95 per cent confidence intervals of overall survival data, were tabulated from eligible studies. The relationship of cyclo-oxygenase-2 expression with survival outcome (expressed as hazard ratio) and treatment response (expressed as odds ratio) in nasopharyngeal carcinoma patients was analysed, and explained with the aid of forest plot charts.
RESULTS AND CONCLUSION: The pooled hazard ratio for overall survival was 2.02 (95 per cent confidence interval = 1.65-2.47). This indicates that the over-expression of cyclo-oxygenase-2 is significantly associated with the poor survival of nasopharyngeal carcinoma patients. The pooled odds ratio of 0.98 (95 per cent confidence interval = 0.27-3.49) reveals that over-expression of cyclo-oxygenase-2 was not significantly related to the treatment outcome.