Displaying all 15 publications

  1. Saiboon IM, Singmamae N, Jaafar MJ, Muniandy BK, Sengmamae K, Hamzah FA, et al.
    Saudi Med J, 2014 Jul;35(7):718-23.
    PMID: 25028229
    To evaluate the effectiveness of a new patient flow system, `The Red Box` on the quality of patient care in respect of the time taken for the care to be delivered to the patient.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  2. Mohammed KI, Zaidan AA, Zaidan BB, Albahri OS, Albahri AS, Alsalem MA, et al.
    Comput Methods Programs Biomed, 2020 Mar;185:105151.
    PMID: 31710981 DOI: 10.1016/j.cmpb.2019.105151
    CONTEXT: Telemedicine has been increasingly used in healthcare to provide services to patients remotely. However, prioritising patients with multiple chronic diseases (MCDs) in telemedicine environment is challenging because it includes decision-making (DM) with regard to the emergency degree of each chronic disease for every patient.

    OBJECTIVE: This paper proposes a novel technique for reorganisation of opinion order to interval levels (TROOIL) to prioritise the patients with MCDs in real-time remote health-monitoring system.

    METHODS: The proposed TROOIL technique comprises six steps for prioritisation of patients with MCDs: (1) conversion of actual data into intervals; (2) rule generation; (3) rule ordering; (4) expert rule validation; (5) data reorganisation; and (6) criteria weighting and ranking alternatives within each rule. The secondary dataset of 500 patients from the most relevant study in a remote prioritisation area was adopted. The dataset contains three diseases, namely, chronic heart disease, high blood pressure (BP) and low BP.

    RESULTS: The proposed TROOIL is an effective technique for prioritising patients with MCDs. In the objective validation, remarkable differences were recognised among the groups' scores, indicating identical ranking results. In the evaluation of issues within all scenarios, the proposed framework has an advantage of 22.95% over the benchmark framework.

    DISCUSSION: Patients with the most severe MCD were treated first on the basis of their highest priority levels. The treatment for patients with less severe cases was delayed more than that for other patients.

    CONCLUSIONS: The proposed TROOIL technique can deal with multiple DM problems in prioritisation of patients with MCDs.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  3. Nasarudin NM, Mohd Saiboon I, Ismail AK
    Eur J Emerg Med, 2013 Oct;20(5):335-8.
    PMID: 22976462 DOI: 10.1097/MEJ.0b013e328358fa40
    Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  4. Al-Sohaim SI, Awang R, Zyoud SH, Rashid SM, Hashim S
    Hum Exp Toxicol, 2012 Mar;31(3):274-81.
    PMID: 21478291 DOI: 10.1177/0960327111405861
    The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  5. Gan SY, Saedon NI, Sukanya S, Fairuz NHA, Sakinah SMN, Fatin NIAH, et al.
    Med J Malaysia, 2017 08;72(4):203-208.
    PMID: 28889130 MyJurnal
    No abstract available.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  6. Albahri OS, Albahri AS, Mohammed KI, Zaidan AA, Zaidan BB, Hashim M, et al.
    J Med Syst, 2018 Mar 22;42(5):80.
    PMID: 29564649 DOI: 10.1007/s10916-018-0943-4
    The new and ground-breaking real-time remote monitoring in triage and priority-based sensor technology used in telemedicine have significantly bounded and dispersed communication components. To examine these technologies and provide researchers with a clear vision of this area, we must first be aware of the utilised approaches and existing limitations in this line of research. To this end, an extensive search was conducted to find articles dealing with (a) telemedicine, (b) triage, (c) priority and (d) sensor; (e) comprehensively review related applications and establish the coherent taxonomy of these articles. ScienceDirect, IEEE Xplore and Web of Science databases were checked for articles on triage and priority-based sensor technology in telemedicine. The retrieved articles were filtered according to the type of telemedicine technology explored. A total of 150 articles were selected and classified into two categories. The first category includes reviews and surveys of triage and priority-based sensor technology in telemedicine. The second category includes articles on the three-tiered architecture of telemedicine. Tier 1 represents the users. Sensors acquire the vital signs of the users and send them to Tier 2, which is the personal gateway that uses local area network protocols or wireless body area network. Medical data are sent from Tier 2 to Tier 3, which is the healthcare provider in medical institutes. Then, the motivation for using triage and priority-based sensor technology in telemedicine, the issues related to the obstruction of its application and the development and utilisation of telemedicine are examined on the basis of the findings presented in the literature.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  7. Iqhbal KM, Ahmad NH
    Med J Malaysia, 2020 09;75(5):585-586.
    PMID: 32918431
    No abstract provided.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  8. Yunos NM, Bellomo R, Taylor DM, Judkins S, Kerr F, Sutcliffe H, et al.
    Emerg Med Australas, 2017 Dec;29(6):643-649.
    PMID: 28597505 DOI: 10.1111/1742-6723.12821
    OBJECTIVE: Patients commonly receive i.v. fluids in the ED. It is still unclear whether the choice of i.v. fluids in this setting influences renal or patient outcomes. We aimed to assess the effects of restricting i.v. chloride administration in the ED on the incidence of acute kidney injury (AKI).

    METHODS: We conducted a before-and-after trial with 5008 consecutive ED-treated hospital admissions in the control period and 5146 consecutive admissions in the intervention period. During the control period (18 February 2008 to 17 August 2008), patients received standard i.v. fluids. During the intervention period (18 February 2009 to 17 August 2009), we restricted all chloride-rich fluids. We used the Kidney Disease: Improving Global Outcomes (KDIGO) staging to define AKI.

    RESULTS: Stage 3 of KDIGO-defined AKI decreased from 54 (1.1%; 95% confidence interval [CI] 0.8-1.4) to 30 (0.6%; 95% CI 0.4-0.8) (P = 0.006). The rate of renal replacement therapy did not change, from 13 (0.3%; 95% CI 0.2-0.4) to 8 (0.2%; 95% CI 0.1-0.3) (P = 0.25). After adjustment for relevant covariates, liberal chloride therapy remained associated with a greater risk of KDIGO stage 3 (hazard ratio 1.82; 95% CI 1.13-2.95; P = 0.01). On sensitivity assessment after removing repeat admissions, KDIGO stage 3 remained significantly lower in the intervention period compared with the control period (P = 0.01).

    CONCLUSION: In a before-and-after trial, a chloride-restrictive strategy in an ED was associated with a significant decrease in the incidence of stage 3 of KDIGO-defined AKI.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  9. Stephens TJ, Bamber JR, Beckingham IJ, Duncan E, Quiney NF, Abercrombie JF, et al.
    Implement Sci, 2019 08 23;14(1):84.
    PMID: 31443689 DOI: 10.1186/s13012-019-0932-0
    BACKGROUND: Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy.

    METHODS: Prospective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams' ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project.

    RESULTS: Chole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others' experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway.

    CONCLUSION: Collaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  10. Abdul Rahman N', Nurumal MS, Awang MS, Mohd Shah ANS
    Australas Emerg Care, 2020 Dec;23(4):240-246.
    PMID: 32713770 DOI: 10.1016/j.auec.2020.06.005
    INTRODUCTION: Emergency departments (EDs) routinely provide discharge instructions due to a large number of patients with mild traumatic brain injury (mTBI) being discharged home directly from ED. This study aims to evaluate the quality of available mTBI discharge instructions provided by EDs of Malaysia government hospitals.

    METHODS: All 132 EDs were requested for a copy of written discharge instruction given to the patients. The mTBI discharge instructions were evaluated using the Patient Education Materials Assessment-Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established guidelines.

    RESULTS: 49 articles were eligible for the study. 26 of the articles met the criteria of understandability, and 3 met the criteria for actionability. The average readability level met the ability of average adult. Most of the discharge instructions focused on emergency symptoms, and none contained post-concussion features.

    CONCLUSION: Majority of the discharge instructions provided were appropriate for average people to read but difficult to understand and act upon. Important information was neglected in most discharge instructions. Thus, revision and future development of mTBI discharge instruction should consider health literacy demand and cognitive ability to process such information.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  11. Embong H, Md Isa SA, Harunarashid H, Abd Samat AH
    Australas Emerg Care, 2021 Jun;24(2):84-88.
    PMID: 32847734 DOI: 10.1016/j.auec.2020.08.001
    BACKGROUND: There is high variability among clinicians' decision of appropriate cardiopulmonary resuscitation (CPR) duration before deciding for termination of resuscitation. This study attempted to investigate factors associated with the decision to prolong resuscitation attempts in cardiac arrest patients treated in an emergencydepartment (ED).

    METHODS: A retrospective study that evaluated two years of mortality registry starting in 2015 was conducted in the ED of University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Adult out-hospital cardiac arrest (OHCA) patients treated in the ED were included. Multivariate logistic regression analysis was utilized for the exploration of factors associated with prolonged CPR attempts (> 30min).

    RESULTS: The median CPR duration was 24min (range 2-68min). Four variables were independently associated with prolonged CPR attempts: younger age (OR, 0.97; 95% CI, 0.95-0.99; p<0.001), pre-existing heart disease (OR, 1.97; 95% CI, 1.07-3.65; p=0.031), occurrence of transient return of spontaneous circulation (ROSC) (OR, 2.38; 95% CI, 1.05-5.36; p=0.037), and access to the ED by nonemergency medical services (EMS) transport (OR, 1.92; 95% CI, 1.09-3.37; p=0.024).

    CONCLUSION: Patient-related and access-related factors were associated with prolonged CPR attempts among OHCA patients resuscitated in the ED.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  12. Chen CH, Shin SD, Sun JT, Jamaluddin SF, Tanaka H, Song KJ, et al.
    PLoS Med, 2020 10;17(10):e1003360.
    PMID: 33022018 DOI: 10.1371/journal.pmed.1003360
    BACKGROUND: Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the "golden hour" for injured patients.

    METHODS AND FINDINGS: We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]-upper quartile [Q3]: 25-62), and 15,498 (63.6%) patients were male. Median (Q1-Q3) RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: 16-29), and 47 (Q1-Q3: 32-60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92-1.06, p = 0.740), 1.08 (95% CI 1.00-1.17, p = 0.065), and 1.03 (95% CI 0.98-1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04-1.08, p < 0.001), 1.05 (95% CI 1.01-1.08, p = 0.007), and 1.06 (95% CI 1.04-1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management.

    CONCLUSIONS: Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the "golden hour" for trauma patients during prehospital care in the countries studied.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  13. Lee CY, Osman SS, Noor HM, Isa NSA
    Sultan Qaboos Univ Med J, 2018 Nov;18(4):e541-e544.
    PMID: 30988978 DOI: 10.18295/squmj.2018.18.04.020
    A congenital pulmonary airway malformation (CPAM) is a rare cystic anomaly that may occur during development of the fetal airways. The vast majority of CPAMs are detected in neonates; as such, it is unusual for diagnosis to occur in adulthood. We report a 21-year-old male patient who presented to the emergency department of the Hospital Ampang, Kuala Lumpur, Malaysia, in 2015 with chest pain, breathlessness and tachypnoea. Based on an initial chest X-ray, the patient was misdiagnosed with pneumothorax and underwent urgent chest tube insertion; however, his condition deteriorated over the course of the next three days. Further imaging was suggestive of infected bullae or an undiagnosed CPAM. The patient therefore underwent video-assisted thoracoscopic surgery, during which a large infected bulla was resected. A diagnosis of an infected CPAM was confirmed by histopathological examination. Following the surgery, the patient recovered quickly and no bullae remnants were found at a one-month follow-up.
    Matched MeSH terms: Emergency Service, Hospital/organization & administration
  14. Bamber JR, Stephens TJ, Cromwell DA, Duncan E, Martin GP, Quiney NF, et al.
    BJS Open, 2019 12;3(6):802-811.
    PMID: 31832587 DOI: 10.1002/bjs5.50221
    Background: Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance.

    Methods: Patients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods.

    Results: Of 13 sites invited to join Chole-QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P 

    Matched MeSH terms: Emergency Service, Hospital/organization & administration*
  15. Adi O, Via G, Salleh SH, Chuan TW, Rahman JA, Muhammad NAN, et al.
    Am J Emerg Med, 2021 Nov;49:385-392.
    PMID: 34271286 DOI: 10.1016/j.ajem.2021.06.031
    STUDY OBJECTIVE: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED).

    METHODS: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate.

    RESULTS: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP.

    CONCLUSION: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.

    Matched MeSH terms: Emergency Service, Hospital/organization & administration
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