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

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.

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.

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.

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.

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

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.

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.
Accidents, Traffic ; Embolism, Fat ; diagnosis ; diagnostic imaging ; Femoral Fractures ; complications ; diagnostic imaging ; Humans ; Intracranial Embolism ; diagnosis ; diagnostic imaging ; Male ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo study the effects of an alpha(1)-adrenoceptor antagonist, terazosin on the androgen-independent prostate cancer cell lines PC-3 and DU145.

METHODSTwo androgen independent cell lines, PC-3 and DU145, were used to determine cell viability, colony-forming ability, as well as cell cycle distribution, after exposure to terazosin. Western blot analysis was used to determine the expression of p21WAF1 and p27KIP1.

RESULTSThis study shows that terazosin inhibits not only prostate cancer cell growth but also its colony forming ability, both of which are main targets of clinical treatment. In addition, terazosin is shown to inhibit cell growth through G1 phase cell cycle arrest and the up-regulation of p27(KIP1).

CONCLUSIONThis study provides evidence that the alpha(1)-adrenoceptor antagonist terazosin may have therapeutic potential in the treatment of advanced hormone refractory prostate cancer.

Adrenergic alpha-Antagonists ; pharmacology ; Antineoplastic Agents ; pharmacology ; Cell Division ; drug effects ; Cell Line ; Humans ; Male ; Prazosin ; analogs & derivatives ; pharmacology ; Prostatic Neoplasms ; pathology ; Tumor Cells, Cultured