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Fulltext Exploratory study of brain waves and corresponding brain regions of fatigue on-call doctors using quantitative electroencephalogram

Xavier G, Su Ting A, Fauzan N

J Occup Health, 2020 Jan;62(1):e12121.
PMID: 32515890 DOI: 10.1002/1348-9585.12121

OBJECTIVES: It is common to find doctors working long and odd hours and many at times without rest and sleep. Despite the evidence of adverse risk, jeopardizing patient safety under the hands of fatigue doctors under such working hours has not changed in many places. It has argued that with such training and subsequent experience, such issues with patient safety reduce. Fatigue too is argued as subjective, as those who can withstand the stress still perform. Nevertheless, undeniably working under fatigue is not safe for both the patient and the doctor. This study is a novel attempt to explore and objectify the state of fatigue using quantitative EEG among post-call doctors.
METHOD: Seven volunteer post-call doctors were recruited to go through an EEG recording before and after their on-call rotation while at rest and subsequently while carrying out Stroop Test, putting their cognitive function at work.
RESULTS: The doctors have worked up to 33 hours in a row and have had sleep of an average of 1.5 hours. It is found that during task there is a statistically significant increase in theta (frontal and occipital regions) and beta (occipital region) band power while at task post-call. Alpha band power is increased in the frontal and reduced in other regions. Correlation with Stroop Test results indicated that those who have higher alpha, beta, and lower relative theta powers at the frontal region at post-call rest have higher percentage of correct congruent trials.
CONCLUSION: The results objectively imply that these fatigue doctors are under more strain while carrying out a task and corresponds to the implicated regions of brain stimulated by the task accordingly.
Fulltext The measurement of mental fatigue following an overnight on-call duty among doctors using electroencephalogram

Su AT, Xavier G, Kuan JW

PLoS One, 2023;18(7):e0287999.
PMID: 37406016 DOI: 10.1371/journal.pone.0287999

This study aimed to measure the spectral power differences in the brain rhythms among a group of hospital doctors before and after an overnight on-call duty. Thirty-two healthy doctors who performed regular on-call duty in a tertiary hospital in Sarawak, Malaysia were voluntarily recruited into this study. All participants were interviewed to collect relevant background information, followed by a self-administered questionnaire using Chalder Fatigue Scale and electroencephalogram test before and after an overnight on-call duty. The average overnight sleep duration during the on-call period was 2.2 hours (p<0.001, significantly shorter than usual sleep duration) among the participants. The mean (SD) Chalder Fatigue Scale score of the participants were 10.8 (5.3) before on-call and 18.4 (6.6) after on-call (p-value < 0.001). The theta rhythm showed significant increase in spectral power globally after an overnight on-call duty, especially when measured at eye closure. In contrast, the alpha and beta rhythms showed reduction in spectral power, significantly at temporal region, at eye closure, following an overnight on-call duty. These effects are more statistically significant when we derived the respective relative theta, alpha, and beta values. The finding of this study could be useful for development of electroencephalogram screening tool to detect mental fatigue.
Fulltext Factors Associated with Tuberculosis Mortality in Manjung District, Perak, Malaysia

Qamruddin AA, Xavier G, Zahid SM

Malays J Med Sci, 2023 Jun;30(3):167-175.
PMID: 37425385 DOI: 10.21315/mjms2023.30.3.15

BACKGROUND: Tuberculosis (TB) is a communicable disease which contributes to a major cause of ill health. Worldwide, it is one of the leading causes of death from a single infectious agent.
OBJECTIVES: The study aimed to describe the epidemiology and factors associated with TB mortality in Manjung district, Perak, Malaysia.
METHODS: All confirmed TB cases from 2015 to 2020 registered in Manjung district under Sistem Maklumat Tibi (MyTB) were included. Factors associated with TB mortality were analysed by using simple and multiple logistic regression analysis.
RESULTS: A total of 742 TB cases were included in the analysis, from which 121 cases (16.3%) died before completing their treatment. The highest death was reported in 2020 (25.7%) and the lowest in 2019 (12.9%). From multiple logistic regression analysis, age 45 years old-64 years old (adjusted OR = 3.62; 95% CI: 1.38, 9.54), > 65 years old (adjusted OR = 8.67; 95% CI: 3.17, 23.74), non-Malaysian (adjusted OR = 5.18; 95% CI: 2.04, 13.14), cases notified by government hospitals (adjusted OR = 6.78; 95% CI: 3.04, 15.09), HIV-positive status (adjusted OR = 8.60; 95% CI: 3.58, 20.67) and HIV testing not offered/unknown (adjusted OR = 2.58; 95% CI: 1.18, 5.62) were significantly associated with TB mortality.
CONCLUSION: This study found that TB patients who were 45 years old and above, positive HIV, late diagnosis and are foreigners had a higher risk for TB mortality. Early diagnosis, optimised screening and close monitoring should be practised to reduce TB mortality.
Fulltext Audit on cardiovascular disease preventive care in general practice

Chan SC, Lee TW, Teoh LC, Abdullah ZC, Xavier G, Sim CK, et al.

Singapore Med J, 2008 Apr;49(4):311-5.
PMID: 18418523

INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit.
METHODS: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards.
RESULTS: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics.
CONCLUSIONS: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.