Introduction: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population. Methods: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria. Results: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant. Conclusion: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.
Colistin ; Intensive Care Units

Introduction: This review aimed to summarise the trend ofmammogram screening uptake published in local studiesbetween years 2006 and 2015 among the Malaysian womenaged 40 years and above, and identify the associated factorsand barriers, as well as discuss limitations of the studiesand research gaps.Methods: A systematic review was conducted on breastcancer screening studies among Malaysian women,published between January 2006 and December 2015.Online databases were searched using keywords:“mammogram”, “mammography”, “uptake”, “breast cancerscreening” and “Malaysia”.Results: Thirteen original articles were reviewed. The rate ofmammography uptake ranged between 3.6% and 30.9%among the general population, and 80.3% among personnelof a tertiary hospital. Factors associated with mammogramscreening were clinical breast examination, age, income,knowledge on breast cancer and mammogram, perceivedsusceptibility to breast cancer, ethnicity and education level.Barriers to mammogram screening were lack of knowledge,embarrassment, fear of cancer diagnosis, perception thatbreast screening was unnecessary, lack of coping skills andpain during procedure. However, almost all of the studiescould not be generalised beyond the study sample becauseof the limited number of sites and respondents; and mostdata were self-reported with no objective measures of theresponses.Conclusion: Mammogram screening uptake among womenin selected communities were generally low. Further studiesinvolving the general population are essential. Futurestudies should also explore the availability, affordability andaccessibility of this service especially in the pursuit ofachieving universal health coverage in breast cancermanagement.

Introduction: This article aims to describe the effect of an intervention to promote the practice of voluntary Islamic fasting and its barriers among a group of overweight and obese Muslim women working in the public sector in Malaysia. Materials and methods: In this quasi-experimental study, an intervention to encourage voluntary fasting was delivered in a half day seminar, supported by relevant booklets prepared. A self-administered questionnaire was used to capture data on voluntary fasting practices and its perceived barriers before and four months after the intervention. Data was analysed using Mc Nemar test to compare the proportion before and after the intervention. Significant level was set at p<0.05. Results: A total of 56 women were recruited. Their mean age was 36.65 years, most were married, had formal education up to secondary level and median income of RM 3000 per month. At baseline, 60.7% of them have practiced voluntary fasting. After intervention, the number of participants who practices voluntary fasting increased with a significant increase in three types of voluntary fasting (i.e. Mondays only, Thursdays only and 6 days in Shawal). The highest barrier to practice voluntary fasting was having no motivation to do so, followed by work commitment, health problems and family commitment. Discussion and Conclusion: Most of the respondents could practice voluntary fasting regularly if motivated to do so and backed by social support both at work and at home.

Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was conducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.

Electronic Medical Records (EMRs) have great value in healthcare, as they enhance healthcare quality, decrease costs, optimize patient safety and health care research. Worldwide and particularly in the Middle Eastern countries have pushed for usage and implement EMR systems. However, there were some obstacles and challenges toward implementation of the EMR system. This review aims to look at the challenges and constraints of using and adopting EMR in Middle Eastern countries. Electronic databases of PubMed, country reports, newspaper, magazine articles, and hospital reports between 2008 to 2021 were used. Most common challenges highlighted were high cost of EMR implementation, lack of training, insufficient information technology personnel support, poor acceptance of new technology, confidentiality, and privacy concerns. Understanding the hurdles of using EMR technology in health care setting is essential for decision makers to focus on economic and human factors challenges to enhance the use and acceptance of EMR systems.

The Coronavirus disease 2019 (COVID-19) pandemic has caused a worldwide human resource crisis in the healthcare setting due to the continuous and overwhelming demand of the workforce. Failure in managing the human resource will negatively affect the clinical management, prevention, and control of the pandemic; while a well-planned human resource policy can ensure sustainable and sufficient skilful workers to meet the demand. This article presents policies that are recommended by the World Health Organization (WHO) and other significant studies in addressing the issues faced by many countries during this COVID-19 pandemic. As with all policies, there are various challenges in the implementation of policies related to COVID-19. Therefore, this article also discusses the challenges in the implementation of these policies. This article ends with the proposal for the way forward in human resource management during a pandemic, should another pandemic hit the world.

Introduction: Workplace safety culture (WSC) is crucial in providing a safe working environment. Workers need to be reminded regularly of its importance, and therefore effectively, work safety intervention programs need to be identified to be used for this purpose. The main objective is to identify workplace intervention programs to improve WSC among office workers. The specific goals are to determine the types of intervention (knowledge-based, attitudinal, and practices-based interventions), the theories used, and the effectiveness. Methods: Databases such as ProQuest, CINAHL, Medline, and ScienceDirect were used to perform literature searches with the keywords [“safety culture training” OR “safety culture education” OR “safety culture promotion”] AND [“office workers” OR “civil servant” OR “white-collar workers” OR “administrative officers” OR “clerical officer”]. The inclusion criteria set for the search process included research articles, publication between January 1, 2015, and September 10, 2020, which were research articles within five years and eight months of publication to the time of data extraction of this study. Availability of full-text articles, articles published in English, and only articles among office workers. Results: This review includes seven articles and the techniques used for these studies were knowledge, attitude, and practices towards WSC. Conclusion: As the number and scope of intervention of studies on WSC seem scarce, the nature of jobs nowadays and in the future seems to be more office-based; consequently, more of these studies are recommended among office workers.

Big data analytics (BDA) in digital health is critical for gaining the knowledge needed to make decisions, with Asia at the forefront of utilising this technology for the Coronavirus disease 2019 (COVID-19). This review aims to study how BDA was incorporated into digital health in managing the COVID-19 pandemic in six selected Asian countries, discuss its advantages and barriers and recommend measures to improve its adoption. A narrative review was conducted. Online databases were searched to identify all relevant literature on the roles of BDA in digital health for COVID-19 preventive and control measures. The findings showed that these countries had used BDA for contact tracing, quarantine compliance, outbreak prediction, supply rationing, movement control, information update, and symptom monitoring. Compared to conventional approaches, BDA in digital health plays a more efficient role in preventing and controlling COVID-19. It may inspire other countries to adopt this technology in managing the pandemic.

Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.