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  1. Ahmed S, Barwick A, Sharma A, Hasan MZ, Kabir MA, Nancarrow S
    PLoS One, 2024;19(7):e0304443.
    PMID: 38950041 DOI: 10.1371/journal.pone.0304443
    Diabetes-related foot complications, including neuropathic plantar forefoot ulcers, are a significant contributor to morbidity and increased healthcare costs. This retrospective clinical audit examines the characteristics of people accessing pedorthics services who are at risk of neuropathic plantar forefoot ulcer (re)occurrence and the pathways and funding models used to access these services. A clinical record audit was conducted on all patients accessing a pedorthics service who had diabetes and neuropathy with a history of plantar forefoot ulceration. The data included demographics, diabetes and neuropathy duration, main forefoot pathology and other comorbidity, footwear and insole interventions, and health fund access status. A total of 70 patient records were accessed, and relevant data was extracted. The mean age of participants was 64.69 (standard deviation (SD) 11.78) years; 61% were male and 39% female. Duration of diabetes ranged from one to 35 years, with a mean of 14.09 years (SD 6.58). The mean duration of neuropathy was 8.56 (SD 4.16) years. The most common forefoot conditions were bony prominences at 71% (n = 50), rigid flat foot and limited joint mobility (53%, n = 37), and hallux abductovalgus at 47% (n = 33). All participants had hyperkeratosis; 34% (n = 24) had forefoot amputation, and around 34% (n = 24) had a history of digital amputation. Various publicly funded packages and private health insurance were accessed. This study investigates the sociodemographic and medical profiles of individuals with diabetes-related foot complexities prone to neuropathic plantar forefoot ulcers. It is the first to examine patients receiving pedorthic services, informing practitioner surveys and preventive care strategies. Understanding patient characteristics aids in optimising multidisciplinary care and reducing ulcer incidence. Further studies are warranted to explore the field to establish an effective multidisciplinary care approach between medical professionals, podiatrists and pedorthists to optimise patient outcomes.
    Matched MeSH terms: Clinical Audit*
  2. Khan, A., Mohd Noor, N.S., Sukumaran, P., Sheikh Aladin, S.H.A., Wai Ying, Y.
    Ann Dent, 2016;22(2):1-8.
    MyJurnal
    This clinical audit is aimed to provide an insight into the performance of dental technicians in rendering
    fixed prosthodontics services at Faculty of Dentistry, University of Malaya. A retrospective audit was
    carried out between 1st of November 2014 and 31st January 2015 using data derived from records and
    monthly returns of the technicians, which are kept at the ceramic laboratory. Retrospective data on
    cases of diagnostic wax-ups, full metal crowns, metal ceramic crowns, all ceramic crowns and bridges
    that were sent to ceramic laboratory for fabrication from 1st of September 2013 to 31st of August 2014
    was systematically extracted from the record and tabulated categorically in SPSS version 22.0. The
    turnaround time in workings day for diagnostic wax-ups and the prostheses was calculated by deducting
    exit date from entry date. Subsequently, the turnaround time and the complexity of cases were categorized
    accordingly. The association of turnaround time and the complexity of the cases was analysed using
    Fisher Exact test with p value < 0.05. Within this time frame, a total of 102 cases of diagnostic waxups,
    36 cases of crown and 18 cases of bridges were fabricated. 57.8% of diagnostic wax-ups were
    completed within 3 days. 100% of 1 unit crown were completed within 7 days and 94.4% of bridges were
    completed within 14 days. There was a significant association of turnaround time and the complexity of
    the cases for diagnostic wax-ups and crowns with p value
    Matched MeSH terms: Clinical Audit
  3. Johnson, D., Badi’ah, Y.
    MyJurnal
    Introduction Clinical guidelines recommend the use of a single antipsychotic drug at standard doses. In clinical practise high-dose and combined antipsychotics are common. Methods A clinical audit of antipsychotic prescribing for patients in a forensic ward in a Malaysian hospital was undertaken using Prescribing Observatory for Mental Health-UK (POMH) standards and compared to POMH data. Results The level of high dose prescribing between Malaysian and the UK was comparable. There were low levels of the use of ‘as required’ (PRN) medication in Malaysia compared to the UK. The use of combined prescribing was more common in Malaysia. Discussion Levels of high dose antipsychotic prescribing are unsatisfactory across both jurisdictions. Specific quality improvements in Malaysia need to centre on the use of combination antipsychotics.
    Matched MeSH terms: Clinical Audit
  4. Mizuno H, Fukuda S, Fukumura A, Nakamura YK, Jianping C, Cho CK, et al.
    J Radiat Res, 2017 May 01;58(3):372-377.
    PMID: 27864507 DOI: 10.1093/jrr/rrw108
    A dose audit of 16 facilities in 11 countries has been performed within the framework of the Forum for Nuclear Cooperation in Asia (FNCA) quality assurance program. The quality of radiation dosimetry varies because of the large variation in radiation therapy among the participating countries. One of the most important aspects of international multicentre clinical trials is uniformity of absolute dose between centres. The National Institute of Radiological Sciences (NIRS) in Japan has conducted a dose audit of participating countries since 2006 by using radiophotoluminescent glass dosimeters (RGDs). RGDs have been successfully applied to a domestic postal dose audit in Japan. The authors used the same audit system to perform a dose audit of the FNCA countries. The average and standard deviation of the relative deviation between the measured and intended dose among 46 beams was 0.4% and 1.5% (k = 1), respectively. This is an excellent level of uniformity for the multicountry data. However, of the 46 beams measured, a single beam exceeded the permitted tolerance level of ±5%. We investigated the cause for this and solved the problem. This event highlights the importance of external audits in radiation therapy.
    Matched MeSH terms: Clinical Audit*
  5. Karobari MI, Khijmatgar S, Noorani TY, Assiry A, Alharbi T
    J Conserv Dent, 2021 02 10;23(5):518-521.
    PMID: 33911363 DOI: 10.4103/JCD.JCD_220_19
    Objective: The aim of this study is to determine the role of clinical audit in improving endodontic treatment outcomes.

    Materials and Methods: An audit at the department of endodontics at dental specialty centre kingdom of Saudi Arabia was carried out. The audit was conducted by developing endodontics treatment and success predictors based on evidence, that can be measured for endodontic care. A total of 12 months' data was examined from the previous dental records. Ten clinical cards were which included root canal treatment were selected. The audit was carried out for a minimum of 50 teeth and a maximum of 200 teeth. The radiographs of record cards were studied and a single dentist completed the audit tool.

    Results: The vitality test was performed in 1.98% cases, intra-canal medicament was used and named in 3.96% cases, 3.96% the teeth were extracted due to endodontic failure. Further, in 6.93% of the cases that were identified had certain spaces but overall root canal filling was evaluated as satisfactory.

    Conclusion: The vitality test, type of intracanal medicament, and assessment of root canal filling were not done, but there was an overall performance of predictors for endodontic treatment.

    Matched MeSH terms: Clinical Audit
  6. Teh CL, Chuah SL, Lee HK, Wan SA, Leong TS, Tan FHS, et al.
    Med J Malaysia, 2020 03;75(2):191-193.
    PMID: 32281610
    Osteoporosis is commonly underdiagnosed and undertreated. We performed a clinical audit to assess the risk factors and clinical care for osteoporosis among older persons who attended medical clinic during a 4-week period in August 2013. There was a total of 128 patients with a mean age of 73.1±5.8 years, and 20.3%. had a history of fall. Fracture Risk Assessment Tool (FRAX) scores assessment showed 14.2% and 68.8% had a 10-year risk of major osteoporotic and hip fractures respectively. Only 6.3% underwent Dual-energy X-ray absorptiometry (DXA) and 73.4% did not receive any preventive treatment for osteoporosis. Older persons attending medical clinic at high risk of osteoporosis fractures did not receive appropriate screening and treatment. There is a need to improve the suboptimal care for bone health among older persons.
    Matched MeSH terms: Clinical Audit
  7. Anizal, I., Saperi, S., Aljundi, M.
    Medicine & Health, 2008;3(2):239-246.
    MyJurnal
    The increasing health care cost and public awareness on the delivery of high quality services has forced healthcare service providers to look into the healthcare delivery system. Clinical Pathway (CP) has been introduced in many hospitals and has been accepted as a beneficial tool in assisting healthcare organizations worldwide. Further, the CP also provides consistently high quality and coordinates services with minimum resources. It is proven to be a beneficial tool in other countries. CP is recently being introduced into the Malaysian healthcare system. The aim of this article was to high-light the benefits of CP in improving healthcare quality and controlling the medical cost. The relevant articles have been reviewed.  The majority of literature reviewed con-cluded that there were positive effects in  implementing CP. The CP was found to be significant in reducing length of stay and medical cost. The introduction of evidence based medicine, clinical outcomes, clinical audit, multidisciplinary communication, teamwork and care planning were also improved by CP. The challenges for healthcare providers and healthcare managers are to participate and be fully committed in path-way development and implementation in order to improve healthcare quality and cost control. 
    Matched MeSH terms: Clinical Audit
  8. Kuay HS, Lee S, Centifanti LC, Parnis AC, Mrozik JH, Tiffin PA
    Int J Law Psychiatry, 2016 Jul-Aug;47:60-7.
    PMID: 27016774 DOI: 10.1016/j.ijlp.2016.02.035
    Although family violence perpetrated by juveniles has been acknowledged as a potentially serious form of violence for over 30years, scientific studies have been limited to examining the incidence and form of home violence. The present study examined the prevalence of family aggression as perpetrated by youths; we examined groups drawn from clinic-referred and forensic samples. Two audits of case files were conducted to systematically document aggression perpetrated by referred youths toward their family members. The purpose of the first audit was fourfold: i) to identify the incidence of the perpetration of family aggression among clinical and forensic samples; ii) to identify whether there were any reports of weapon use during aggressive episodes; iii) to identify the target of family aggression (parents or siblings); and iv) to identify the form of aggression perpetrated (verbal or physical). The second audit aimed to replicate the findings and to show that the results were not due to differences in multiple deprivation indices, clinical diagnosis of disruptive behavior disorders, and placement into alternative care. A sampling strategy was designed to audit the case notes of 25 recent forensic Child and Adolescent Mental Health Service (CAMHS) cases and 25 demographically similar clinic-referred CAMHS cases in the first audit; and 35 forensic cases and 35 demographically similar clinic-referred CAMHS cases in the second audit. Using ordinal chi-square, the forensic sample (audit 1=64%; audit 2=82.9%) had greater instances of family violence than the clinical sample (audit 1=32%; audit 2=28.6%). They were more likely to use a weapon (audit 1=69%; audit 2=65.5%) compared to the clinical sample (audit 1 and 2=0%). Examining only the aggressive groups, there was more perpetration of aggression toward parents (audit 1, forensic=92%, clinical=75%; audit 2, forensic=55.17%, clinical=40%) than toward siblings (audit 1, forensic=43%, clinical=50%; audit 2, forensic=27.58%, clinical=30%). Based on these findings, we would urge professionals who work within the child mental health, particularly the forensic area, to systematically collect reports of aggression perpetrated toward family members.

    Study conducted in England
    Matched MeSH terms: Clinical Audit/legislation & jurisprudence
  9. Tan HS, Balasubramaniam IS, Hss AS, Yeong ML, Chew CC, Singh RP, et al.
    BMC Pediatr, 2019 05 29;19(1):174.
    PMID: 31142302 DOI: 10.1186/s12887-019-1550-3
    BACKGROUND: Prolonged neonatal jaundice (PNNJ) is often caused by breast milk jaundice, but it could also point to other serious conditions (biliary atresia, congenital hypothyroidism). When babies with PNNJ receive a routine set of laboratory investigations to detect serious but uncommon conditions, there is always a tendency to over-investigate a large number of well, breastfed babies. A local unpublished survey in Perak state of Malaysia revealed that the diagnostic criteria and initial management of PNNJ were not standardized. This study aims to evaluate and improve the current management of PNNJ in the administrative region of Perak.

    METHODS: A 3-phase quasi-experimental community study was conducted from April 2012 to June 2013. Phase l was a cross-sectional study to review the current practice of PNNJ management. Phase ll was an interventional phase involving the implementation of a new protocol. Phase lll was a 6 months post-interventional audit. A registry of PNNJ was implemented to record the incidence rate. A self-reporting surveillance system was put in place to receive any reports of biliary atresia, urinary tract infection, or congenital hypothyroidism cases.

    RESULTS: In Phase I, 12 hospitals responded, and 199 case notes were reviewed. In Phase II, a new protocol was developed and implemented in all government health facilities in Perak. In Phase III, the 6-month post-intervention audit showed that there were significant improvements when comparing mean scores of pre- and post-intervention: history taking scores (p 

    Matched MeSH terms: Clinical Audit*
  10. Teh CL, Cheong YK, Wan SA, Ling GR
    Reumatismo, 2019 Oct 24;71(3):154-159.
    PMID: 31649384 DOI: 10.4081/reumatismo.2019.1225
    Treat-to-target (T2T) for gout has been established recently to improve its management, which has been reported to be sub-optimal with significant gaps between the goals of treatment and day-to-day clinical practice. T2T recommended a goal of serum urate (SUA) target of <360 μmoI/L in all patients with gout and <300 μmoI/L in patients with tophaceous or severe gout. T2T strategy was applied in the management of gout patients in two Rheumatology clinics from 1 January 2016 onwards. We performed a clinical audit to assess T2T of SUA in gout patients and to identify causes for failure to achieve target SUA among them. There were a total of 304 patients for our analysis. They were of multi-ethnic origin with male predominance (88.8%). They had a mean age of 57.7+13.7 years and mean disease duration of 10.1+8.7 years. The most common comorbidities were hypertension (76.2%), dyslipidemia (52.5%) and diabetes mellitus (DM) (27.4%). Our patients' body mass indexes showed that 47.7% were obese while 34.2% were overweight. Up to 62.4% of our patients had tophi and 42.6% had joint deformities. Only 34.9% of patients achieved target SUA. Nonadherence (52.3%) was the main reason identified for failure to achieve target SUA. The independent predictors for failure to achieve target SUA were nonadherence (HR=7.84, p=0.000) and presence of tophi (HR=1.95, p=0.001).
    Matched MeSH terms: Clinical Audit
  11. Tay KH, Ariffin F, Sim BL, Chin SY, Sobry AC
    Malays J Med Sci, 2019 Jul;26(4):101-109.
    PMID: 31496899 MyJurnal DOI: 10.21315/mjms2019.26.4.12
    Background: Antimicrobial resistance is a global problem that is perpetuated by the inappropriate use of antibiotics among doctors. This study aims to assess the antibiotic prescription rate for patients with acute upper respiratory infection (URI) and acute diarrhoea.

    Methods: A completed clinical audit cycle was conducted in 2018 in the busy emergency department of a public hospital in Malaysia. Pre- and post-intervention antibiotic prescription data were collected, and changes were implemented through a multifaceted intervention similar to Thailand's Antibiotics Smart Use programme.

    Results: Data from a total of 1,334 pre-intervention and 1,196 post-intervention patients were collected from the hospital's electronic medical records. The mean (SD) age of participants was 19.88 (17.994) years. The pre-intervention antibiotic prescription rate was 11.2% for acute diarrhoea and 29.1% for acute URI, both of which are above the average national rates. These antibiotic prescription rates significantly reduced post-intervention to 6.2% and 13.7%, respectively, falling below national averages. Antibiotic prescription rate was highest for young children. There were no significant changes in rates of re-attendance or hospital admission following the intervention.

    Conclusion: The multifaceted intervention, which included continuing medical education, physician reminders and patient awareness, was effective in improving the antibiotic prescription rates for these two conditions.

    Matched MeSH terms: Clinical Audit
  12. Lip HTC, Lip HTC, Lip HTC, Huei TJ, Huei TJ, Huei TJ, et al.
    J Coll Physicians Surg Pak, 2019 Feb;29(2):185-186.
    PMID: 30700363 DOI: 10.29271/jcpsp.2019.02.185
    This is a retrospective audit of all patients admitted to the surgical unit for urosepsis from June 2014 to June 2015 at the General Surgery Unit of Hospital Sultan Ismail, Malaysia. Demographics, comorbidities, presenting symptoms, length of stay (LOS), mortality, and associated risk factors were recorded. There were 35 patients treated for urosepsis with a male preponderance of 21/35 patients. Hypertension (n=18) and diabetes (n=10) were the two most common comorbidities. There were five deaths (mortality rate=14.3%) and the main bacterium cultured was Escherichia coli. Age >65, presence of underlying comorbid disease, presence of cancer, urine and blood culture positivity had higher incidence of death but were not statistically significant for urosepsis mortality. However, this result is limited by the small sample size and single centre retrospective data.
    Matched MeSH terms: Clinical Audit
  13. Ching SM, Hassan F, Paimin F
    MyJurnal
    The National Clinical Practice Guideline in Tuberculosis (TB) was designed to improve the quality of tuberculosis care. However, it remains unknown whether primary care doctors adhere to it well. This audit aims to assess the quality of care in the process of TB contact tracing in a primary care setting. Methods: Data on TB contact tracing from 1st February 2013 to 15th February 2013 was obtained retrospectively from all medical records of diagnosed pulmonary TB in a public primary care clinic. All patients who fulfilled the inclusion and exclusion criteria were included in the study. Results: A total of 102 medical records of adult TB contacts were recruited. The median age of the TB contact was 34 (IQR=10) years and 65 % were male. Seventy two percent of the adult TB contact had a TBIS 10C3 form created, and 95% of the medical records were fully documented. History taking and physical examination were recorded on 97% and 99% of patients respectively during the first follow-up at the polyclinic. Eighty five percent and 100% of the patients had a chest-x-ray and sputum direct smear for acid-fast bacilli done respectively. The turn-up rate for the first, second, third and fourth visit was 100% to 32%, 10% and 2% respectively. Conclusion: The quality of care for adult TB contacts tracing in this clinical audit was found to be suboptimal. There is a difference between the current national guidelines and practice in the clinic. Certain measures to improve the quality of care for adult TB contact tracing
    are urgently needed.
    Matched MeSH terms: Clinical Audit
  14. Sazlina SG, Zailinawati AH, Zaiton A, Ong I
    MyJurnal
    Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year. Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5 %. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6 mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was
    found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour.
    Matched MeSH terms: Clinical Audit
  15. Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, et al.
    BMC Infect Dis, 2017 03 15;17(1):213.
    PMID: 28298208 DOI: 10.1186/s12879-017-2198-y
    BACKGROUND: Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.

    METHODS: We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.

    RESULTS: From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years - lifetime risk is approximately one-third. Average incidence of 3-10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients' quality of life and incur heavy healthcare utilisation.

    CONCLUSIONS: Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.

    Matched MeSH terms: Clinical Audit
  16. Shiang SW, Vendargon SJ, Hamid SRBGS
    J Coll Physicians Surg Pak, 2019 Apr;29(4):371-374.
    PMID: 30925964 DOI: 10.29271/jcpsp.2019.04.371
    OBJECTIVE: To determine the wound complications post coronary artery bypass graft surgery (CABG) by conventional vein harvest technique (CVH) and minimally invasive vein harvest technique (MIVH) in Hospital Sultanah Aminah Johor Bahru, Malaysia.

    STUDY DESIGN: Clinical audit report.

    PLACE AND DURATION OF STUDY: Hospital Sultanah Aminah Johor Bahru, Malaysia, from March 2016 to May 2017.

    METHODOLOGY: Data were collected retrospectively from all 127 patients who underwent CABG with saphenous vein grafts, either with CVH technique (n=68), or MIVH technique (n=59) performed with Vasoview system. The rate of wound dehiscence was evaluated. Patients with severe wound dehiscence that required readmission and surgical intervention were identified for further evaluation.

    RESULTS: There was total 26.8% of wound dehiscence in our study, which was not appreciably different between two groups (p=0.092). Patient with severe wound breakdown that required surgical intervention was significantly less in MIVH group (1/59, 1.7%) compared to CVH group (8/68, 11.8%, p=0.037). There was no significant difference in readmission rate between MIVH and CVH group (p=0.574).

    CONCLUSION: There is significant reduction in severity of wound dehiscence post-saphenous vein harvesting among CABG patients with MIVH technique. However, there is no statistical difference in wound dehiscence and readmission rate between MIVH and CVH technique.

    Matched MeSH terms: Clinical Audit
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