On the Occasion of 10th Anniversary
Medicine and Health.2016;11(1):1-.
Medicine and Health
2002 (v1, n1) to Present ISSN: 1671-8925
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Adverse Drug Reaction with Midazolam Use in Emergency Department
Medicine and Health.2016;11(1):2-10.
Midazolam is one of the most commonly used drugs for sedation in Emergency
Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical
Centre (UKMMC). The objective was to elicit the frequency of side effects and
correlation to various factors i.e. socio-demography, co-morbidities, age groups
and underlying illnesses. Out of 380 patients, 35 patients experienced side effects
(20 patients with midazolam alone, 15 patients with combination of drugs). The
average age was 42 years and the average dose of midazolam was 3.5mg. The
most common other drug combined was fentanyl. The overall complication rate
for midazolam was 5.3%. The most common side effect recorded was excessive
somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting
(0.8%), headache (0.8%) and hypotension (0.5%). There was no significant
association between the socio-demographic factors and drugs combination with
the side effects of midazolam on patients. It was concluded that midazolam was a
safe drug due to absence of any life-threatening side effects. There are possibilities
that most side effects recorded could be caused by other comfounding factors e.g.
underlying injuries or disease and combination with other drugs.
Midazolam
Midazolam
Medicine and Health.2016;11(1):22-28.
The objectives were to identify factors associated with early revisit of adult patients
with acute asthma exarcebation discharged from the Emergency Department (ED).
It was a retrospective cohort study with patients aged 12 years or more within a
period of 1 month and who were treated for acute asthma and discharged from the
ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria
and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these
revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid
was found to be low (24.9%) and abscond rate was high (25.1%). Patients who
absconded from the ED and their concurrent infection were associated with early
ED revisit.
Asthma
Asthma
Medicine and Health.2016;11(1):29-37.
Patients who self-discharge against medical advice (DAMA) are susceptible to
life-threatening consequences. By understanding the factors associated with
DAMA, healthcare centres can build strategies to assist patients to receive optimal
medical care and prevent unfavourable outcome. The objective of this study was
to determine the factors associated with DAMA from the Emergency Department
(ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a
prospective unmatched case control study conducted over a 4-month period. For
every DAMA episode, two patients who were admitted on the same day were
randomly selected as control. Following patient consent, data was collected using
a standardized questionnaire. Patients were contacted by the investigator for
information regarding hospitalization within two weeks of DAMA. Ninety three
patients were recruited; 31 DAMA patients and 62 admitted patients. Payment
method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01).
The likelihood of self-paying patients to take DAMA was three times higher than
those who had a guarantor letter from their employer or insurance provider. Other
factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-
15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total
of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6%
DAMA patients were admitted to hospital within two weeks of the DAMA episode.
Payment method significantly influences DAMA. Payment planning, social welfare
services, non-governmental organization funds and the introduction of a national
health policy scheme may aid hospital payment, alleviate financial limitation of
patients and reduce DAMA episodes.
Patient Discharge
Patient Discharge
Medicine and Health.2016;11(1):38-46.
Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary
resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at
Emergency Department (ED) increases the chance of survival from sudden cardiac
arrest. The main objective of this study was to identify the factors that influenced
the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC). The second objective was to determine the incidence
of CPR initiated by the public prior to ambulance arrival. The present study was a
one-year cross-sectional study. The OHCA patients were identified from the ED
resuscitation logbook. Patients’ medical records were used to obtain details of the
resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene
CPR, use of automated external defibrillators (AEDs), mode of transportation and
the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical
data was analysed using chi-square and Fisher exact tests. Nine patients out of 98
had early CPR. Three patients achieved ROSC. Gender was significantly associated
with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC
compared to those who received late CPR. The provision of early CPR and usage
of AEDs by the public is still low. Female gender had a positive influence on ROSC.
Efforts are required to increase the awareness and involvement of the public in
initiating early CPR prior to the arrival of ambulance service.
Cardiopulmonary Resuscitation
Cardiopulmonary Resuscitation
Paramedics’ Perception on Video Assisted Learning Method in Learning Emergency Skills
Medicine and Health.2016;11(1):47-55.
Information technology use in healthcare education has become a popular
medium of instruction. One of the medium of instruction is video assisted learning
(VAL). The use of VAL as an instructional method in the teaching and learning of emergency skills is not new. However, there are lack of studies on the perception of
using this method in learning emergency skills. This qualitative study involved four
focused discussion groups following a VAL instruction on emergency skills. A total
of 20 paramedics were divided into four groups. They were involved in a focussed
discussion after a VAL instruction session. Findings reveal that the paramedics
perceived three major themes which were categorized as : i) advantages of video
as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on
using video as teaching tool. The findings indicate that the paramedics perceived
VAL as a potential tool for learning emergency skills. However, they suggested the
language of instruction should be in their mother tongue for better understanding.
This implies that using English language has disadvantage in technology enhanced
learning for better understanding.
Computer-Assisted Instruction
Computer-Assisted Instruction
Structured Education Programme on Patient Controlled Analgesia (PCA) for Orthopaedic Patients
Medicine and Health.2016;11(1):62-71.
Patient-controlled analgesia (PCA) via an infusion pump enables patient to
administer their own analgesia. The aim of this study was to evaluate the effect
of an educational programme in managing post-operative pain and satisfaction
on PCA following orthopedic surgery. A pre-test and post-test interventional study
design with implementation of patient education programme on PCA was provided
to 54 respondents. The control group received conventional PCA briefing from
the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and
24 hrs following surgery and pre-test and post-test of the Revised American Pain
Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There
was difference in respondents’ level of pain score among the study respondents’
medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were
7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs,
6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and
1.00 (IQR=1.00) respectively. There were significant differences in median of pain
score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50,
p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically
significant differences (p<0.05) in the median of patient’s pain severity at all pain
levels i.e. least pain, worst pain, and severe pain between intervention and control
group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain,
U=49.0, p<0.05). In conclusion, patients who received pre-operative structured
education programme showed improvement in managing post-operative pain and
satisfaction on PCA after orthopedic surgery.
Analgesia, Patient-Controlled
Analgesia, Patient-Controlled
Medicine and Health.2016;11(1):72-82.
The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially
useful for local research on hypoglycaemia. However, it requires adaptation and
validation in local settings. This study reports the process and results of cross-cultural
adaptation and linguistic validation of HypoSRQ for Malay and English versions in
our local setting. The HypoSRQ underwent forward and backward translation and
adaptation with support from professional translators and a clinical psychologist.
Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes
mellitus from varying sociodemographic backgrounds. Discussion was done
together with the original developers of the HypoSRQ to decide on the best version
for local use. The finalised versions were proofread and formatted with the help
of Health Psychology Research. Cognitive debriefing for Malay version involved 7
patients and for the English version5 patients. Direct literal translation into Malay
language was unsuitable due to technical terms which were difficult for laypersons
to understand. Amendments were made based on findings from the cognitive
debriefing process. Participants found the questionnaire fairly easy to understand.
The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by
local participants. These tools may undergo psychometric evaluation for future
use in local settings.
Diabetes Mellitus ; Surveys and Questionnaires
Diabetes Mellitus ; Surveys and Questionnaires
Is Electroconvulsive Therapy Safe for Patient with Very Low BMI? A Case Report
Medicine and Health.2016;11(1):83-86.
A case of rapid stabilization using electroconvulsive therapy (ECT) for a major
depressive disordered (MDD) patient with life-threatening low body mass index
(BMI) is reported. This case report focuses on a 55-year-old Malay housewife with
underlying hyperthyroidism in a euthyroid state who presented with MDD with
mood congruent psychotic features, which were precipitated by the death of her
husband. Her BMI was only 11 kg/m2
due to severe anorexia, and she was highly
suicidal. Peripheral total parenteral nutrition was started and ECT was commenced
for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout
admission. The patient was discharged at BMI of 13 kg/m2
with good appetite. ECT
was safe for very low BMI MDD patient.
Electroconvulsive Therapy ; Depressive Disorder, Major
Electroconvulsive Therapy ; Depressive Disorder, Major
Sexual Pain Disorder with Anxiety and Depressive Psychopathology as Complication: A Case-Report
Medicine and Health.2016;11(1):87-91.
Vaginismus is a sexual dysfunction which results from vaginal musculature spasm
and makes the penetration almost impossible. It is commonly associated with
significant emotional distress. On several occasions, fear of pain during sexual
intercourse may perpetuate the sexual dysfunction. We report a case of primary
vaginismus that was associated with psychiatric squeale of anxiety and depression
psychopathology. It suggests that psychological problems related to a mentalhealth
problem in vaginismus should be dealt adequately for a holistic approach.
A combination of behavioural, psychological and pharmacological treatment is
important to ensure a good prognosis outcome.
Vaginismus ; Sexual Dysfunctions, Psychological
Vaginismus ; Sexual Dysfunctions, Psychological
Country
Malaysia
Publisher
Universiti Kebangsaan Malaysia Medical Centre
ElectronicLinks
http://medicineandhealthukm.comEditor-in-chief
Dr Srijit Das
editor@ppukm.ukm.my
Abbreviation
Med & Health
Vernacular Journal Title
ISSN
1823-2140
EISSN
2289-5728
Year Approved
Current Indexing Status
Currently Indexed
Start Year
Since 2006
Description
Medicine and Health is a peer-reviewed journal and published bi-annual. The primary purpose of this journal is to publish the results of study and research concerning all disciplines of medicine and health sciences, including dentistry, dietetics, medical education and nursing.
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