Waiting is a common phenomenon in the doctor's waiting room. The purpose of this audit is to assess patient waiting time and doctor consultation time in a primary healthcare clinic and to formulate strategies for improvement. This audit was conducted at a primary care clinic for 4 weeks using the universal sampling method. All patients who attended the clinic during this period was included in the study except for those who required more time to be seen such as those who were critically ill, aggressive or those who came for repeat medication or procedures only without needing to see the doctor. The time of arrival was captured using the queue management system (QMS) and then the patient was given a timing chit which had to be manually filled by the staff at every station. The waiting time for registration, pre-consultation, consultation, appointment, payment and pharmacy were recorded as well as consultation time. The data were entered into the statistical software SPSS version 17 for analysis. version 17. Results showed that more than half of the patients were registered within 15 minutes (53%) and the average total waiting time from registration to seeing a doctor was 41 minutes. Ninety-nine percentage of patients waited less than 30 minutes to get their medication. The average consultation time was 18.21 minutes. The problems identified in this audit were addressed and strategies formulated to improve the waiting and consultation time were carried out including increasing the number of staff at the registration counter, enforcing the staggered appointment system for follow-up patients and improving the queuing system for walk-in patients.
The timing of ABG procedure in a cleft patient is crucial to provide room and bony
support for the eruption of canine. However, there seems to be a delay in execution of this
procedure in certain centres. Material and Methods: Sample consists of records of cleft patients
treated from 2000-2016. The date and age for commencement of active orthodontic treatment,
date referred for ABG and date ABG done were retrieved. The centres that conducted these
surgeries identified. (Copied from article).
Newtonian and special-relativistic predictions, based on the same model parameters and initial conditions for the trajectory of a low-speed scattering system are compared. When the scattering is chaotic, the two predictions for the trajectory can rapidly diverge completely, not only quantitatively but also qualitatively, due to an exponentially growing separation taking place in the scattering region. In contrast, when the scattering is nonchaotic, the breakdown of agreement between predictions takes a very long time, since the difference between the predictions grows only linearly. More importantly, in the case of low-speed chaotic scattering, the rapid loss of agreement between the Newtonian and special-relativistic trajectory predictions implies that special-relativistic mechanics must be used, instead of the standard practice of using Newtonian mechanics, to correctly describe the scattering dynamics.
Fast and computationally less complex feature extraction for moving object detection using aerial images from unmanned aerial vehicles (UAVs) remains as an elusive goal in the field of computer vision research. The types of features used in current studies concerning moving object detection are typically chosen based on improving detection rate rather than on providing fast and computationally less complex feature extraction methods. Because moving object detection using aerial images from UAVs involves motion as seen from a certain altitude, effective and fast feature extraction is a vital issue for optimum detection performance. This research proposes a two-layer bucket approach based on a new feature extraction algorithm referred to as the moment-based feature extraction algorithm (MFEA). Because a moment represents the coherent intensity of pixels and motion estimation is a motion pixel intensity measurement, this research used this relation to develop the proposed algorithm. The experimental results reveal the successful performance of the proposed MFEA algorithm and the proposed methodology.
'Causal' direction is of great importance when dealing with complex systems. Often big volumes of data in the form of time series are available and it is important to develop methods that can inform about possible causal connections between the different observables. Here we investigate the ability of the Transfer Entropy measure to identify causal relations embedded in emergent coherent correlations. We do this by firstly applying Transfer Entropy to an amended Ising model. In addition we use a simple Random Transition model to test the reliability of Transfer Entropy as a measure of 'causal' direction in the presence of stochastic fluctuations. In particular we systematically study the effect of the finite size of data sets.
Schizophrenia is a common and devastating illness. Patients with schizophrenia may develop many disabilities both due to the disease process as well as due to side effects of the medication used. There are many advances in the treatment of schizophrenia, which can effectively reduce many of these disabilities. Treatment of schizophrenia is a primary health care responsibility and thus all health care personnel need to equip themselves with the latest knowledge on management issues. This article outlines the current management issues in schizophrenia.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
Mobile Augmented Reality (MAR) requires a descriptor that is robust to changes in viewing conditions in real time application. Many different descriptors had been proposed in the literature for example floating-point descriptors (SIFT and SURF) and binary descriptors (BRIEF, ORB, BRISK and FREAK). According to literature, floating-point descriptors are not suitable for real-time application because its operating speed does not satisfy real-time constraints. Binary descriptors have been developed with compact sizes and lower computation requirements. However, it is unclear which binary descriptors are more appropriate for MAR. Hence, a distinctive and efficient accuracy measurement of four state-of-the-art binary descriptors, namely, BRIEF, ORB, BRISK and FREAK were performed using the Mikolajczyk dataset and ALOI dataset to identify the most appropriate descriptor for MAR in terms of computation time and robustness to brightness, scale and rotation changes. The obtained results showed that FREAK is the most appropriate descriptor for MAR application as it able to produce an application that are efficient (shortest computation time) and robust towards scale, rotation and brightness changes.
Existing structural components require strengthening after a certain period of time due to increases in service loads, errors in design, mechanical damage, and the need to extend the service period. Externally-bonded reinforcement (EBR) and near-surface mounted (NSM) reinforcement are two preferred strengthening approach. This paper presents a NSM technique incorporating NSM composites, namely steel and carbon fiber-reinforced polymer (CFRP) bars, as reinforcement. Experimental and analytical studies carried out to explore the performance of reinforced concrete (RC) members strengthened with the NSM composites. Analytical models were developed in predicting the maximum crack spacing and width, concrete cover separation failure loads, and deflection. A four-point bending test was applied on beams strengthened with different types and ratios of NSM reinforcement. The failure characteristics, yield, and ultimate capacities, deflection, strain, and cracking behavior of the beams were evaluated based on the experimental output. The test results indicate an increase in the cracking load of 69% and an increase in the ultimate load of 92% compared with the control beam. The predicted result from the analytical model shows good agreement with the experimental result, which ensures the competent implementation of the present NSM-steel and CFRP technique.
This study attempts to trace changes in the wet spells over Peninsular Malaysia based on the daily rainfall data from 32 selected rainfall stations which include four sub-regions; northwest, west, south and east, for the period of 1975 to 2004. Six wet spells indices comprising of the main characteristics (maximum, mean, standard deviation), the persistency of two consecutive wet days and the frequency of the short and long duration of wet spells will be used to identify whether or not these indices increase or decrease over Peninsular Malaysia during the monsoon seasons. The study indicates that the eastern areas of the peninsula could be considered as the wettest areas since almost all the indices of wet spells over these areas are higher than over the other regions during the northeast monsoon (NE). The Mann-Kendall (MK) trend test revealed that almost all of the stations located in the eastern areas of the peninsula exhibited a positive trend in the mean, variability and persistency of wet spells indices during the NE monsoon, while a negative trend was observed during the southwest monsoon (SW) in these areas. Moreover, these indices showed a positive trend, and at the same time a decreasing trend was observed in the frequency of the long wet spells in most stations located over the west coast of Peninsular Malaysia during the SW monsoon for the period of 1975 to 2004.
Patients are increasingly dissatisfied with the “waiting time” and “duration of consultation” at outpatient clinics. A cross sectional study was carried out to measure waiting time and duration of consultation and to examine patients’ level of satisfaction towards waiting time and duration of consultation at the Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also examined patient’s satisfaction towards the overall clinic services. Data was collected using a self-administered questionnaire. A total of 81 patients participated in this study with a response rate of 100 percent. Findings indicated a significant difference in the mean between expected waiting time level II (from the time the patient is given the calling number till the time patient is called into the doctor’s room) and the actual waiting time level II experienced. A significant difference in the mean between the expected duration of consultation and the actual duration of consultation experienced was also noted. However, no significant difference was found between the mean of expected waiting time level I (the time patient register at the counter till the patient is given the calling number) and the actual waiting time (p>0.05). Overall, patient satisfaction towards waiting time was low (29.6%) and duration of consultation was of moderate level (41.9%). The overall satisfaction towards the clinic services were of average level (56.8%). Findings also indicated that patient satisfaction was not influenced by socio-demographic factors of respondents such as age, ethnic, education level, occupation and income level. Important findings from this study may help staff managing the clinic in addressing patients’ complaint on waiting time and improve patients’ satisfaction on the overall services of the Orthopedic clinic in UKMMC.
Study site: Orthopedic clinc, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fannia prisca Stein, 1918 is newly recorded from peninsular Malaysia. This record is based on 4 male specimens from Mount Berembun, Brinchang, Cameron Highland, Pahang state, peninsular Malaysia. It is previously recorded from China, Mongolia, Korea, Japan, Taiwan, Bonin Island, Thailand and oriental region. The male of Fannia prisca can be differentiated from male Fannia scalaris by the following features: for F. prisca, mid-coxa without spine; mid-tibia normal or without stout triangular ventral projection; and hind tibia usually with 2 av, while F. scalaris has several stout hook-like spines on the anterior margin; mid-tibia with stout triangular ventral projection and hind tibia usually with 3 av. Both F. prisca and F. scalaris can be differentiated from Fannia leucosticta by looking at its hind tibia, which only has 1 av.
We have used electron probe microanalysis to examine Southeast Asian nephrite (jade) artifacts, many archeologically excavated, dating from 3000 B.C. through the first millennium A.D. The research has revealed the existence of one of the most extensive sea-based trade networks of a single geological material in the prehistoric world. Green nephrite from a source in eastern Taiwan was used to make two very specific forms of ear pendant that were distributed, between 500 B.C. and 500 A.D., through the Philippines, East Malaysia, southern Vietnam, and peninsular Thailand, forming a 3,000-km-diameter halo around the southern and eastern coastlines of the South China Sea. Other Taiwan nephrite artifacts, especially beads and bracelets, were distributed earlier during Neolithic times throughout Taiwan and from Taiwan into the Philippines.
The aim of this study was to determine the accumulation of settling particles in coral reefs of Peninsular Malaysia. Settling particles were collected from the coral reefs of Port Dickson, Pulau Langkawi, Pulau Tioman, Pulau Redang and Pulau Tinggi from 2005 to 2008. The average total settling particles in Pulau Langkawi and Port Dickson was 49.8 mg/cm2/day, while for Pulau Tioman, Pulau Redang, and Pulau Tinggi was 3.5 mg/cm2/day. The results showed that accumulations rate in west coast were higher than east coast of Peninsular Malaysia. However, Pulau Tioman in the east coast received high accumulations rate of settling particles in certain times of the year due to sediment resuspension at shallow reefs caused by high energy seasonal yearly wave and monsoon.
Effective waste management has been greatly restricted by insufficient statistical data on the generation, processing and waste disposal. This study was undertaken in the municipality of Tehran. A total of 6,060 samples were compared by statistically comparing source generation, destination and intermediate stations. The results from these analyses showed that the average per capita waste generation in Tehran was 589 g day(-1). It was also observed that, of the total amount of waste generated in the municipality of Tehran, 73% was domestic waste and 27% was non-domestic waste. In addition, 68% of total household waste was organic waste, while 41% of non-domestic waste was organic waste. Furthermore, 61% of waste in Tehran was generated at the source, while 72% of the waste coming into the Aradkoh disposal and processing center was organic waste. The physical analysis was showed that there was no significant difference between the wastes generated in 2004 and those generated in 2009 and that there was not equal percentage of wet waste coming into the disposal center with urban service stations. This indicates that active source separation programs in metropolitan Tehran.
INTRODUCTION: Several studies have found higher in-hospital mortality for admissions during weekend or off hours, known as "weekend or off-hour effect". However, data for this on Malaysian populations is limited. This study was conducted to analyze the 3-year mortality trend in a secondary hospital and its relation to time and date of admission.
METHODS: The clinical data of 126,627 patients admitted to Taiping Hospital from 1st January 2008 to 31st December 2010 obtained via patient registry database of hospital was analyzed. This study compared mortality during weekdays with weekends, office hours (0800-1700) with off hours (1701-0759), and subanalysis of office hours with evening (1701-2259) or night hours (2300-0759), adjusted for age and gender.
RESULTS: Although the overall staff-to-patient ratio is improving, analyses showed a statistically significant increased risk of mortality for those patients admitted during weekends (OR = 1.22; 95% confidence interval [CI] = 1.14-1.31) or off hours in a weekday (OR = 1.67; 95% CI = 1.57-1.78). In the comparison between time of admission, there was statistically significant increased risk of mortality for admissions during evening hours (OR = 1.44; 95% CI = 1.28-1.62) and night hours (OR = 1.92; 95% CI = 1.71-2.16). Diseases of cardiovascular and respiratory system remained the top two causes of death over the three years.
CONCLUSION: The risk of mortality is significantly higher as a result of "weekend or off-hour effect". Recognition and intervention addressing these issues will have important implications for the healthcare system setting, hospital staffing and training, quality and timeliness of medical care delivery.