1.Predictors of mortality in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI): Insights from National Cardiovascular Disease Database (NCVD), Malaysia
Jaya Purany Stanley Ponniah ; Shamsul Azhar Shah ; Mohamad Adam Bujang
The Medical Journal of Malaysia 2012;67(6):601-605
The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary
intervention. Estimation of post operative mortality risk
factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data
extracted from the National Cardiovascular Disease
Database (NCVD-ACS and NCVD PCI). Both these registries
were interlinked and was further matched to JPN (Jabatan
Pendaftaran Negara/National registration Department) to
assess mortality among the patients who underwent PCI and
all death which occurred in between 2007, 2008 and 2009.
There were 630 patients in this studied. Age, history of
diabetes mellitus, peripheral vascular, renal failure and
previous percutaneous coronary intervention were
univariately associated with mortality. However based on
logistics stepwise method, only age and history of renal
failure had showed statistically significant and sizeable
odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.
2.Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study
Voon Hian Yan ; Leong May Shi ; Li Chean Wen ; Mohamad Adam Bujang ; Haris Njoo Suharjono
The Medical Journal of Malaysia 2017;72(5):259-263
Background: In the course of managing preterm labour,
increasing trends of total white cell count raises concern for
the obstetrician, suggesting a possible underlying
infectious aetiology. Although mild leukocytosis is expected
in pregnancy, the patterns of increment after corticosteroid
administration are not well described beyond animal models
and in a small number of human studies.
Methods: Seventy-three consecutive patients who required
antenatal corticosteroids for either preterm labour or
prelabour caesarean section were recruited and given a
standard course of 12mg dexamethasone phosphate, twelve
hours apart. Venous blood samples were taken before
administration, at six hours and 36 hours after the first dose
of dexamethasone.
Results: The total white count trend was 10.31±2.62 at
baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours.
Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and
3.24±1.49 respectively, reflecting relative neutrophilia and
lymphopenia which normalised by 36 hours.
Conclusion: In contrast to previous studies, we found only a
slight increment in total white cell count of about 10%. The
marginal changes described in our study would not
normally raise any clinical concern, although vigilance
should be exercised if higher levels were observed.
Leukocytosis
;
Pregnancy
3.An elaboration on sample size determination for correlations based on effect sizes and confidence interval width: a guide for researchers
Restorative Dentistry & Endodontics 2024;49(2):e21-
Objectives:
This paper aims to serve as a useful guide for sample size determination for various correlation analyses that are based on effect sizes and confidence interval width.
Materials and Methods:
Sample size determinations are calculated for Pearson’s correlation, Spearman’s rank correlation, and Kendall’s Tau-b correlation. Examples of sample size statements and their justification are also included.
Results:
Using the same effect sizes, there are differences between the sample size determination of the 3 statistical tests. Based on an empirical calculation, a minimum sample size of 149 is usually adequate for performing both parametric and non-parametric correlation analysis to determine at least a moderate to an excellent degree of correlation with acceptable confidence interval width.
Conclusions
Determining data assumption(s) is one of the challenges to offering a valid technique to estimate the required sample size for correlation analyses. Sample size tables are provided and these will help researchers to estimate a minimum sample size requirement based on correlation analyses.
4.Validation of the Malay version of Diabetes Quality of Life (DQOL) Questionnaire for Adult Population with Type 2 Diabetes Mellitus
Mohamad Adam Bujang ; Mastura Ismail ; Nur Khairul Bariyyah Mohd Hatta ; Siti Haslina Othman ; Nurakmal Baharum ; Siti Sara Mat Lazim
Malaysian Journal of Medical Sciences 2017;24(4):86-96
Objective: We aimed to validate the Malay version of Diabetes Quality of Life (DQOL) questionnaire for Malaysian adult population with type 2 diabetes mellitus (DM). Methods: This is a cross-sectional study to validate Malay version of DQOL among the adult diabetic patients. DQOL questionnaire has 46 items consist of three domains, namely Satisfaction Domain, Impact Domain and Worry Domain. Both forward and backward translations from the English version of DQOL into Malay version were performed. After the face validity of the Malay version was established, it was then pilot-tested. Finally, the validity and reliability of the final Malay version of DQOL questionnaire were evaluated. Results: There were 290 patients participated in this study with a mean (SD) age of 53.1 (10.0) years. The Cronbach's alpha coefficients of the overall items and the main domains were between 0.846 and 0.941. The Pearson's correlation coefficients for the three domains were between 0.228 and 0.451. HbA1C was found to be positively correlated with Impact Domain (P = 0.006). The Worry Domain was associated with diabetic retinopathy (P = 0.014) and nephropathy (P = 0.033). Conclusion: The Malay version of diabetes quality of life (DQOL) questionnaire was found to be a valid and reliable survey instrument to be used for Malaysian adult patients with diabetes mellitus.
5.Value of Shock Index in Prognosticating The Short Term Outcome of Death for Patients Presenting With Severe Sepsis and Septic Shock in The Emergency Department
Shah Jahan Mohd Yussof ; Mohd Idzwan Zakaria ; Fatahul Laham Mohamed ; Mohamad Adam Bujang ; Sharmila Lakshmanan ; Abu Hassan Asaari
The Medical Journal of Malaysia 2012;67(4):406-411
Introduction: The importance of early recognition and
treatment of sepsis and its effects on short-term survival
outcome have long been recognized. Having reliable
indicators and markers that would help prognosticate the
survival of these patients is invaluable and would
subsequently assist in the course of effective dynamic
triaging and goal directed management.
Study Objectives: To determine the prognosticative value of
Shock Index (SI), taken upon arrival to the emergency
department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients.
Methodology: This is a retrospective observational study
involving 50 patients admitted to the University of Malaya
Medical Centre between June 2009 and June 2010 who have
been diagnosed with either severe sepsis or septic shock.
Patients were identified retrospectively from the details
recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The
number of severe sepsis and septic shock cases were 31
(62%), and 19 (38%) respectively. There were 17 (34%) cases
of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%)
cases of gastro intestinal tract related infections and 12
(24%) cases of other infections. There were a total of 23
(46%) survivors and 27 (54%) deaths. The value of the shock
index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome.
Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0.
Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This parameters should be further analyzed in a larger scale prospective study to determine its validity.
6.Risk Factors and Prediction Models for Retinopathy of Prematurity
Mallika Premsenthil ; Mohamad Aziz Salowi ; Mohamad Adam Bujang ; Adeline Kueh ; Chong Min Siew ; Kala Sumugam ; Chan Lee Gaik ; Tan Aik Kah
Malaysian Journal of Medical Sciences 2015;22(5):57-63
Objectives: To develop a simple prediction model for the pre-screening of Retinopathy of
Prematurity (ROP) among preterm babies.
Methods: This was a prospective study. The test dataset (January 2007 until December 2010)
was used to construct risk prediction models, and the validation dataset (January 2011 until March
2012) was used to validate the models developed from the test dataset. Two prediction models were
produced using the test dataset based on logistic regression equations in which the development of
ROP was used as the outcome.
Results: The sensitivity and specificity for model 1 [gestational age (GA), birth weight (BW),
intraventricular haemorrhage (IVH) and respiratory distress syndrome (RDS)] was 82 % and
81.7%, respectively; for model 2, (GA and BW) the sensitivity and specificity were 80.5% and 80.3%,
respectively.
Conclusion: Model 2 was preferable, as it only required two predictors (GA and BW). Our
models can be used for the early prevention of ROP to avoid poor outcomes.
7.Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting
Farnaza Ariffin ; Anis Safura Ramli ; Maryam Hannah Daud ; Jamaiyah Haniff ; Suraya Abdul-Razak ; Sharmini Selvarajah ; Verna KM Lee ; Seng Fah Tong ; Mohamad Adam Bujang
The Medical Journal of Malaysia 2017;72(2):106-112
Introduction: Non-communicable diseases (NCD) is a global
health threat. the Chronic Care Model (CCM) was proven
effective in improving NCD management and outcomes in
developed countries. Evidence from developing countries
including Malaysia is limited and feasibility of CCM
implementation has not been assessed. this study intends
to assess the feasibility of public primary health care clinics
(PHC) in providing care according to the CCM.
Methodology: A cross-sectional survey was conducted to
assess the public PHC ability to implement the components
of CCM. All public PHC with Family Medicine Specialist in
Selangor and Kuala Lumpur were invited to participate. A
site feasibility questionnaire was distributed to collect site
investigator and clinic information as well as delivery of care
for diabetes and hypertension.
results: there were a total of 34 public PHC invited to
participate with a response rate of 100%. there were 20
urban and 14 suburban clinics. the average number of
patients seen per day ranged between 250-1000 patients.
the clinic has a good mix of multidisciplinary team
members. All clinics had a diabetic registry and 73.5% had a
hypertensive registry. 23.5% had a dedicated diabetes and
26.5% had a dedicated hypertension clinic with most clinic
implementing integrated care of acute and NCD cases.
Discussion: the implementation of the essential
components of CCM is feasible in public PHCs, despite
various constraints. Although variations in delivery of care
exists, majority of the clinics have adequate staff that were
willing to be trained and are committed to improving patient
care.
8.Lifestyle factors associated with cardiovascular risk among healthcare workers from the tertiary hospitals in Sarawak
Kuan Pei Xuan ; Chan Weng Ken ; Chua Pin Fen ; John Yeo Jui Ping ; Fatin Ellisya Sapri ; Mohamad Adam Hj Bujang ; Asri Said
Malaysian Family Physician 2020;15(1):15-22
Introduction: A cross-sectional study is used to evaluate the lifestyle factors associated with
cardiovascular disease (CVD) risk among healthcare workers in tertiary hospitals in Sarawak, Malaysia.
Methods: A questionnaire-based survey using the Simple Lifestyle Indicator Questionnaire (SLIQ) was
administered to, and anthropometric measurements were collected from, 494 healthcare workers.
Results: Te mean age of the subjects was 32.4±8.4, with a range of 19 to 59 years. Te subjects were
from the allied health (45.5%), management and professional (25.1%) and executive (29.4%) felds.
Overall, 47.4% of the subjects were of normal weight, 30.2% were overweight, 17.2% were obese and
5.2% were underweight. Te mean number of working hours per week for the subjects was 47.6±14.0
with the highest working hours found among the management and professional group, followed by
the executive and allied health groups. Overall, 39.7% of the healthcare workers worked ofce hours,
36.6% worked within the shift system, 20.9% worked ofce hours and were on-call and the remaining
2.8% worked a mixture of ofce hours and shifts. Based on the SLIQ score, 58.1% were classifed as
at intermediate risk for CVD, 38.5% were in the healthy category and 3.4% were in the unhealthy
category. Factors associated with a healthier lifestyle were being female (Odds Ratio [OR]= 12.1; CI=
3.2- 46.4), professional (mean score= 6.70), in the allied health group (mean score=7.33) and in the
normal BMI group (OR= 9.3, CI= 1.8- 47.0).
Conclusion: In our study, healthcare workers had an intermediate risk of developing CVD in the
future. Tus, there is a need to intervene in the lifestyle factors contributing to CVD.
9.Sample size determination for conducting a pilot study to assess reliability of a questionnaire
Mohamad Adam BUJANG ; Evi Diana OMAR ; Diana Hui Ping FOO ; Yoon Khee HON
Restorative Dentistry & Endodontics 2024;49(1):e3-
This article is a narrative review that discusses the recommended sample size requirements to design a pilot study to assess the reliability of a questionnaire. A list of various sample size tables that are based on the kappa agreement test, intra-class correlation test and Cronbach’s alpha test has been compiled together. For all calculations, type I error (alpha) was set at a maximum value of 0.05, and power was set at a minimum value of 80.0%. For the kappa agreement test, intra-class correlation test, and Cronbach’s alpha test, the recommended minimum sample size requirement based on the ideal effect sizes shall be at least 15, 22, and 24 subjects respectively. By making allowances for a non-response rate of 20.0%, a minimum sample size of 30 respondents will be sufficient to assess the reliability of the questionnaire.The clear guideline of minimum sample size requirement for the pilot study to assess the reliability of a questionnaire is discussed and this will ease researchers in preparation for the pilot study. This study provides justification for a minimum requirement of a sample size of 30 respondents specifically to test the reliability of a questionnaire.
10.The impact on patients’ time-to-theatre following colour coding classification in emergency operation theatre, Sarawak General Hospital
Khaw Soon Keong ; Teo Shu Ching ; Mohamad Adam Bujang
The Medical Journal of Malaysia 2020;75(4):379-384
Introduction: A proper prioritisation system of emergency
cases allows appropriate timing of surgery and efficient
allocation of resources and staff expertise. The aim of this
study was to determine the impact of colour coding
classification on Time-to- theatre (TTT) of patients in
comparison with the normal practice.
Method: Categorisation was a surgical judgment call after
thorough clinical assessment. There were 4 levels of urgency
with their respective TTT; Red (2 hours), Yellow (8 hours),
Green (24 hours), Blue (72 hours). Caesarean cases were
excluded in colour coding due to pre - existing classification.
The data for mean TTT was collected 4 weeks before the
implementation (Stage 1), and another 4 weeks after
implementation (Stage II). As there was a violation in the
assumption for parametric test, Mann Whitney U test was used
to compare the means between these two groups. Using
logarithmic (Ln) transformation for TTT, Analysis of
Covariance (ANCOVA) was conducted for multivariate
analysis to adjust the effect of various departments. The mean
TTT for each colour coding classification was also calculated.
Results: The mean TTT was reduced from 13 hours 48 min to
10 hours, although more cases were completed in Stage II (428
vs 481 cases). Based on Mann-Whitney U test, the difference in
TTT for Stage I (Median=6.0, /IQR=18.9) and Stage II
(Median=4.2, IQR=11.5) was significantly different (p=0.023).
The result remained significant (p=0.039) even after controlled
for various department in the analysis. The mean/median TTT
after colour coding was Red- 2h 24min/1h, Yellow- 8h
26min/3h 45 min, Green- 15h 8min/8h 15min, and Blue- 13h
46min/13h 5min.
Conclusion: Colour coding classification in emergency
Operation (OT) was effective in reducing TTT of patients for
non-caesarean section cases.