1.Improvement in Documentation of Intake and Output Chart
W.W Ling ; LP Ling ; Z.H Chin ; I.T Wong ; A.Y Wong ; A. Nasef, A. Zainuddin
International Journal of Public Health Research 2011;-(Special issue):152-162
Intake and Output (I/O) records in hospitals were often found to be incomplete and illegible. The form used to record I/O is not user-friendly — i.e., they feature miniscule boxes, ‘total’ lines that do not correspond with shift changes and lack of instructions. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. Moreover, Nursing Sisters
objective rounds often saw incompleteness of I/O chart. This study aims to identify the types of mistakes in recording the existing I/O chart. The second aim is to find out whether shift totalling of I/O chart helps in reducing mistakes. We try to determine whether the identified mistakes were repeated in the new I/O Chart. This study was conducted from October till December 2010 in 9 selected wards in Sibu Hospital. Data collection was
divided into 3 phases. A pre-implementation audit using a checklist was carried out. The compliance rate of completeness of documentation of I/O Chart was 63%. A one month trial of new I/O chart was being done in the selected 9 wards. Post implementation audit showed a significant improvement of compliance rate (88%). Feedback
from health care workers (N=110) showed that, 89% of doctors (n=17) and 60% of nurses (n=93) in the sample prefer to use the new format as more practical and relevant to the changing shift of nurses and doctors’ ward round. It is suggested to implement the new format to increase compliance rate of documentation of I/O charting. Briefing should be given to nurses periodically and the new
format should be introduced to nursing students in nursing colleges.
Documentation
;
Forms and Records Control
;
Nursing Records
;
Charts
;
Medical Errors
2.Atretic Cephalocele — An Uncommon Cause of Cystic Scalp Mass
Siong Lung Wong ; Huong Ling Law ; Suzet Tan
Malaysian Journal of Medical Sciences 2010;17(3):61-63
A 6 year-old girl presented with a midline parietal scalp swelling that had been gradually
enlarging since birth. Magnetic resonance imaging revealed communication of the cyst with the
subarachnoid space through a calvarial defect, with concomitant findings of vertically positioned
straight venous sinus and subependymal grey matter heterotopia. A diagnosis of atretic cephalocele
was thus made based on these classical imaging findings.
3.Seizures in a young child following mydriatic eye drops
JJM Wong ; CT Choong ; YLF Ling ; CL Chen
Neurology Asia 2013;18(4):409-412
Cyclopentolate, proparacaine, tropicamide and phenylephrine eye drops are frequently used for
ophthalmological examinations. We report a young child who developed a generalised tonic clonic
seizure on two separate occasions after ocular instillation of these four drugs with the aim of increasing
the awareness of this rare but serious neurotoxic side-effect.
4.Malignant granular cell tumour of the mediastinum.
Soh, Wee Ming ; Yeong, Mee Ling ; Wong, Kwong Pang
The Malaysian Journal of Pathology 2014;36(2):149-51
This report describes a case of malignant granular cell tumour arising in the mediastinum, detailing the investigations undertaken to reach this rare diagnosis. A 63-year-old man was referred from the Pacific Islands for investigation of a 8cm mediastinal mass extending into the left pleura and associated with pleural nodules and pleural effusion. Needle aspiration via bronchoscopy yielded insufficient material for cytological interpretation and needle biopsy showed normal respiratory epithelium. CT-guided FNA revealed scattered large polygonal to spindle cells with granular cytoplasm and indistinct borders. The needle core biopsy yielded scanty cells with abundant granular cytoplasm, oval and regular nuclei which were moderately positive for CD68, vimentin and S100 and negative for CKMNF116, CK5/6, CK7, CK20, TTF-1, chromogranin and synaptophysin. In view of the benign morphology, these cells were interpreted to be histiocytes. The incisional biopsy revealed cords and trabeculae of cells identical to the CT samples. These cells were polygonal with abundant granular cytoplasm. Some cells showed large eosinophilic cytoplasmic globules not seen in the FNA sample. The tumour was however, heterogeneous in appearance with some areas exhibiting criteria of malignancy: necrosis, vesicular nuclei with large nucleoli, high nuclear-to-cytoplasmic ratio and nuclei pleomorphism. In addition, p53 expression in 10% of tumour nuclei, a high Ki67 proliferative rate (>10%), the deep seated location and extension of the tumour into adjacent organs favoured a diagnosis of malignancy.
5.Mother’s mental preparedness for pregnancy : The affecting factors and its effect on birth outcomes
Sharifah Sulaiha Syed Aznal ; Chee Yoong Wong ; Pamela Lee Ling Tan ; Vee Vee See ; Chui King Wong
International e-Journal of Science, Medicine and Education 2014;8(3):19-27
Background: Increased maternal anxiety level has been
reported to have detrimental effects on the physical
outcome of pregnancies such as not achieving vaginal
births. This study thus aims to determine the level and
factors affecting mental preparedness among mothers
with normal pregnancies and its correlation with birth
outcomes.
Methods: Three hundred healthy mothers above 37
weeks of gestation in the early stage of labour were
assessed for their level of mental preparation before birth
process and outcomes after births which include general
feeling (euphoria), ability to withstand labour pain
and bonding with the new born. The successfulness of
vaginal birth and other data on factors affecting mental
preparation were also collected.
Results: The level of mental preparedness was found
good in 78% of the mothers, mainly determined by
their socioeconomic status, family support and personal
ability to adjust to changes. Age (p= 0.048), parity
(0.00) and income (0.01) were found to influence mental
preparedness significantly. Race, occupation, education
level and marital status are however not significantly
related. Poor mental preparedness is associated with
greater pain during labour. A correlation analysis also
found a positive relationship between the level of mental
preparation and mental outcomes following birth in
these mothers but it did not significantly influence the
mode of delivery.
Conclusion: Mental preparation before birth seems to
have an effect on mental outcomes of mothers following
birth process. It is vital that mothers of the younger age
group with no previous obstetric experience be given
more attention in preparing them mentally before they
face the painful birth process.
6.Cervical Ripening Balloon for Induction of Labour in High Risk Pregnancies
Hian Yan Voon ; Angeline TY Wong ; Moi Ling Ting ; Haris Njoo Suharjono,
The Medical Journal of Malaysia 2015;70(4):224-227
Background: The Cervical Ripening Balloon (CRB) is a novel
mechanical method for induction of labour (IOL), reducing
the risks of hyperstimulation associated with
pharmacological methods. However, there remains a paucity
of literature on its application in high risk mothers, who have
an elevated risk of uterine rupture, namely those with
previous scars and grandmultiparity.
Methodology: A retrospective study on IOL using the CRB in
women with previous caesarean section or grandmultiparity
between January 2014 and March 2015. All cases were
identified from the Sarawak General Hospital CRB request
registry. Individual admission notes were traced and data
extracted using a standardised proforma.
Results: The overall success rate of vaginal delivery after
IOL was 50%, although this increases to about two-thirds
when sub analysis was performed in women with previous
tested scars and the unscarred, grandmultiparous woman.
There was a significant change in Bishop score prior to
insertion and after removal of the CRB. The Bishop score
increased by a score of 3.2 (95% CI 2.8-3.6), which was
statistically significant (p<0.01) and occurred across both
subgroups, not limited to the grandmultipara. There were no
cases of hyperstimulation but one case of intrapartum fever
and scar dehiscence each (1.4%). Notably, there were two
cases of change in lie/presentation after CRB insertion.
Conclusion: CRB adds to the obstetricians’ armamentarium
and appears to provide a reasonable alternative for the IOL
in women at high risk of uterine rupture. Rates of
hyperstimulation, maternal infection and scar dehiscence
are low and hence appeals to the user.
Pregnant Women
7.Bacille-Calmette-Guérin vaccine-associated suppurative lymphadenitis in Hong Kong Special Administrative Region (China), 2004 to 2012
Lam Tsz-sum ; Leung Yiu-Hong ; Tsang Hoi-ling ; Choi Kin-wing ; Wong Tin-yau ; Wong Man-ha ; Chuang Shuk-kwan
Western Pacific Surveillance and Response 2013;4(1):39-40
8.How to secure the connection between thoracostomy tube and drainage system?
Ka Ki Pat LI ; Kit Shing John WONG ; Yau Hang Henry WONG ; Cheng Lok KA ; So Ling FUNG ; Lau Leung CHU ; Kam Wah CHAK
World Journal of Emergency Medicine 2014;5(4):259-263
BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials (3M?Transpore? Medical tape, 3M? Micropore? Medical tape, 3M? Soft Cloth Tape on Liner) and three different methods (cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor. RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore?, 31.29 lb for Micropore? and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore? is used (P<0.001). There was no statistical significant difference between Micropore? and Soft Cloth Tape on Liner (P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method (P<0.0001 when compared with plastic band) (P=0.033 when compared with straight method). CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore? is not a recommended material for thoracostomy tube taping.
9.Nipple Reconstruction with Rolled Dermal Graft Support.
Hui Ling CHIA ; Manzhi WONG ; Bien Keem TAN
Archives of Plastic Surgery 2014;41(2):158-162
BACKGROUND: Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection. METHODS: Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively. RESULTS: Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily. CONCLUSIONS: Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.
Bandages
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Breast
;
Cicatrix
;
Dermis
;
Female
;
Humans
;
Mammaplasty
;
Nipples*
;
Rectus Abdominis
;
Superficial Back Muscles
;
Tissue Donors
;
Transplants*
10.Rehabilitation for traumatic brain injury in children and adolescents.
Hwee-Ling YEN ; Janice T Y WONG
Annals of the Academy of Medicine, Singapore 2007;36(1):62-66
Children and adolescents who have sustained a traumatic brain injury (TBI) may be left with multiple deficits and impairments that can impact adversely their abilities to return to premorbid functioning in the home, school and community. Early rehabilitation has been shown to improve functional outcome; the rehabilitation programme itself has to be based on real-world demands and experiences. Rehabilitation has to be continued beyond the post-acute stage in order to promote neuronal re-organisation, monitor the child's development as well as identify and manage new issues that may appear with growth, development and maturation. The availability of relevant research data and findings for children is much less than those for adults. It is not always appropriate to apply data for adults to the younger persons due to important differences in the 2 groups and these are discussed in more detail in the article. Multiple factors have been found to affect recovery and functional outcome. Apart from age and developmental stage at injury, other variables can be grouped as injury-related, patient-related and treatment-related factors. The goals and components of the rehabilitation process are examined for the various stages of recovery and the last section of the article describes the paediatric rehabilitation scene in Singapore.
Adolescent
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Brain
;
physiopathology
;
Brain Injuries
;
epidemiology
;
physiopathology
;
rehabilitation
;
Child
;
Humans
;
Neuronal Plasticity
;
Recovery of Function