INTRODUCTION: Randomised controlled trials (RCTs) have informed guideline recommendations for the management of stable coronary artery disease (CAD). However, the real-world impact of contemporary guidelines and trials on practising physicians in the Asia-Pacific region remains uncertain. We aimed to evaluate the knowledge, attitudes and practices among cardiovascular physicians in the region regarding stable CAD management. METHOD: An anonymised cross-sectional electronic survey was administered to cardiovascular practitioners from the Asia Pacific, assessing 3 domains: 1) baseline knowledge on recent trials and society guideline, 2) attitudes towards stable CAD, and 3) case scenarios reflecting management preferences. Correlations among knowledge, attitudes and practice scores were assessed between physicians from developed and developing countries using Pearson correlation. RESULTS: Overall, 713 respondents from 21 countries completed the survey. The mean knowledge score was 2.90±1.18 (out of 4), with 37.3% of respondents answering all questions correctly, while 74.6% noted that guidelines have significant impact on their practice. Despite guidelines recommending optimal medical therapy, majority chose revascularisation (range 53.4- 90.6%) as the preferred strategy for the case scenarios. Practitioners from developed regions had higher knowledge scores and lower attitude scores compared to developing regions, while practice scores were similar in both groups. Weakly positive correlations were noted between knowledge, attitude and practice scores. CONCLUSION Variations exist in knowledge and attitudes towards guideline recommendations and correspondingly actual clinical practice in the Asia Pacific, with most practitioners choosing an upfront invasive strategy for the treatment of stable CAD. These differences reflect real-world disparities in guideline interpretation and clinical adoption.
Humans ; Coronary Artery Disease/therapy* ; Cross-Sectional Studies ; Practice Patterns, Physicians'/statistics & numerical data* ; Asia ; Health Knowledge, Attitudes, Practice ; Surveys and Questionnaires ; Male ; Practice Guidelines as Topic ; Female ; Attitude of Health Personnel ; Middle Aged ; Developing Countries

Introduction: The problem in patients who are intubated with endotracheal tube is the occurrence of accumulation of secretions. One of the actions to reduce the secretion is closed suction. This research monitors the patient's oxygensaturation and also reveals the effect of closed suction on oxygen and AaDO2 saturation (alveolar-arterial oxygen difference) in patients who were mechanically ventilated in the Intensive Care Unit (ICU) of Dr. Kariadi Hospital. The design of this study uses pre experiment. Methods: The research process has been carried out on April 2, 2019 until May 26, 2019 in the Intensive Care Unit with a total sampling technique, on 15 respondents. Result: The results of the study showed that there was effect of closed suction technique on the value of oxygen saturation in patients with mechanical ventilation (p-value = 0.010). Conclusion: Closed suction can lead to decrease of air volume in the lungs up to 1200 ml. So hyperoxygenation must be done before closed suction as it can reduces the incidence of hypoxemia by 49%. Before closing the suction, it is recommended to do hyperoxygenation.

Nusa Tengara Barat (NTB) province consists of two main islands, Lombok and Sumbawa, to the east of Bali Island, Indonesia. Most of the area is known to be moderately malaria endemic, but the exact malaria epidemiology has not been elucidated. At least 30 deaths per year are thought to be caused by falciparum malaria in Lombok alone, judging from the hospital data. According to the Gebrak Malaria Team in West Lombok, the annual incidence in the district of West Lombok from 1996 to 1999 was consistently over 40‰.
In the present report, we describe the small malaria endemic foci in the West Lombok and Sumbawa districts. Falciparum malaria is predominant over vivax malaria and other types of malaria. There are 11 species of Anopheles vector, but three of these species, An. subpictus, An. maculates and An. barbirostris, are of primary importance in malaria transmission and An. sundaicus and An. aconitus are of secondary importance. Our data from Sekotong, West Lombok, and Sumbawa supported the importance of An. subpictus in coastal areas but suggested the existence of different transmission peaks according to environmental conditions. The usual transmission peak comes in the dry season but is affected by climatic and geographical conditions. Although there were many malaria endemic foci along the coast, the width and grade of the foci varied widely. The presence of malaria endemic foci inland, although likely, has not been definitively reported to date.