Pusat Pengajian Sains Perubatan - Dataset

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    Publication
    Cost Effectiveness of Immediate Tracheostomy versus Early Tracheostomy in Decompressive Craniectomy Patients: A Retrospective Study.
    (2021)
    Hasan, Hezry Abu
    Cost Effectiveness of Immediate Tracheostomy versus Early Tracheostomy in Decompressive Craniectomy Patients: A Retrospective Study Dr. Hezry bin Abu Hasan ’, Dr. Sofan bin Zenian ’, Dr. Regunath Kandasamy 2, Prof. Dato’ Dr. Syed Mohamed Aljunid Syed Junid 3'4. 1. Neurosurgical Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia. 2. Department of Neurosurgery, Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia. 3. Health Policy and Management Department, Faculty of Public Heal±, Kuwait University, Kuwait City, Kuwait. 4. International Center for Casemix and Clinical Coding (ITCC), National University of Malaysia, Kuala Lumpur, Malaysia. Traumatic Brain Injury (TBI) patients often present with refractory intracranial hypertension, necessitating a supratentorial decompressive craniectomy to relieve malignant intracranial pressure and prevent further neurological insult. However, due to the poor neurological condition of these patients, many are electively intubated and put on mechanical ventilation to protect tire airway and facilitate cerebral protective measures. Unfortunately, as a x result of poor and prolonged neurological recovery, many patients have to be put on tracheostomy in view of prolonged intubation. Prolonged mechanical ventilation also inefficiently utilizes the already limited mechanical ventilators and Intensive Care Unit (ICU) beds. In an attempt to maximize our limited hospital resources, we innovate a new method of tracheostomy timing strategy by performing the tracheostomy in the same setting as the supratentorial decompressive craniectomy (Immediate Tracheostomy) in patients who are anticipated to require prolonged mechanical ventilation. We attempt to answer ‘How early should Early Tracheostomy be done?’ by comparing the clinical and cost-saving benefit of the Immediate Tracheostomy strategy. A retrospective study on patients requiring a supratentorial decompressive craniectomy and tracheostomy done within 7 days of the cranial surgery from January 2013 to December 2019 in Hospital Queen Elizabeth was done. Patients receiving a tracheostomy in the same setting of their supratentorial decompressive craniectomy were assigned to the Immediate Tracheostomy (IT) group, whereas those who received a tracheostomy within 7 days of their cranial surgery was assigned to the Early Tracheostomy (ET) group. Normally distributed quantitative data was analyzed using the independent T-test, while non-normally distributed data was analyzed using the Mann-Whitney U-test. Qualitative variables were analyzed with a Chi-square test. Cost of treatment of each patient was obtained based on Malaysian costing database provided by Casemix System MY-DRG. Of 411 patients reviewed, a total of 63 patients were included in the study. 21 patients (33.3%) were allocated to the Immediate Tracheostomy (IT) group and 42 patients (66.7%) in the other. Patients in the Immediate Tracheostomy (IT) group had significantly lower total GCS scores (Median (IQR): 6 (3) versus 9 (4), p = 0.011), reduced duration of mechanical ventilation (Median (IQR): 72 hours (48) versus 120 hours (72), p = 0.001) and sedation (Median (IQR): 48 hours (24) versus 72 hours (54),/? = 0.001), and shorter ICU length of stay (Median (IQR): 72 hours (48) versus 144 hours (96), p = 0.001). Cost reduction with the Immediate Tracheostomy (IT) strategy was estimated to be RM 18,463.14 — RM 39,223 per patient. The diagnosis of severe TBI, total GCS score <6 on presentation, and the presence of Intraventricular Hemorrhage (IVH) on CT brain imaging were identified as possible indicators for patients who will benefit from the Immediate Tracheostomy (IT) strategy. The Immediate Tracheostomy strategy has shown evidence of increasing ICU bed turnover and reducing the cost of treatment. Patients presenting with a total GCS of < 6 and presence of IVH on CT Brain were seen to benefit from Immediate Tracheostomy. With the clinical and treatment cost benefits seen, the Immediate Tracheostomy (IT) strategy should be considered a viable option for the management of Traumatic Brain Injury patients undergoing supratentorial decompressive craniectomy.
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    The efficacy of relaxation therapy as adjunctive therapy on physical function, symptoms and medication intake in patients with knee osteoarthritis.
    (2013)
    Elias, Azlina
    Osteoarthritis is the commonest arthritis especially in the elderly. Despite the usage of pharmacotherapy in managing this disease, psychological therapy such as Guided Imagery Relaxation (GIR) has been shown to reduce stress and pain in various types of chronic diseases. The objective of our study is to determine the efficacy of relaxation therapy as adjunctive therapy on symptoms, physical functions and analgesic consumption in patients with primary knee osteoarthritis. A randomized controlled trial with two arm parallel comparative study for relaxation therapy versus control among patient with knee osteoarthritis was carried out to see the its efficacy in improving pain, symptoms and physical function. Sixty knee osteoarthritic patients were recruited for this study. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to measure pain, symptoms, sports and recreational, activity of daily living and health related quality of live scores among these patients. Analgesic consumption was calculated throughout the intervention period to see the difference between intervention and control groups.The treatment consists of listening to 12 minutes MP3 with prerecorded Guided Imagery with Relaxation Therapy at least once per day for the duration of 8 weeks. ANCOVA test was used to compare the score differences between intervention and control groups after the intei’vention. A total of sixty patients enrolled into the study however only 59 patients completed the study (98.3%). The mean age of the patients is 52.2(7.08).There were significant improvements of pain (p<0.004), activity of daily living (p<0.02), sport score (p<0.005), and quality of life score (p<0.01) in intei’vention group compared to control group. The analgesic score as lower in the intei’vention group, however it was not statistically significant. Guided imagery with Relaxation therapy has shown positive effects in managing patients with knee osteoarthritis. This intei’vention has significantly reduced pain, improve activity of daily living and also health related quality of life. This result justifies further investigations of Guided imagery with Relaxation therapy as self-management in patients with knee osteoarthritis.
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    Level of knowledge and practice regarding dietary intake among patient with End Stage Renal Disease (ESRD) in Hospital Universiti Sains Malaysia (HUSM).
    (2020)
    This research is about the knowledge and practice regarding dietary intake among patients with ESRD in HUSM. Diet plays an important role in slowing down kidney problems and dialysis. The main objective of this study was to determine the knowledge and practices regarding dietary intake in HUSM. A cross-sectional study was conducted on 20 patients from ward 7 Utara, 7 Selatan, Haemodialysis Unit. The majority of 18 (90%) respondents indicated an intermediate knowledge level in dietary intake. Similar results also found that almost 90% of respondents had moderate dietary practices. Meanwhile, there was no significant difference between the level of knowledge and practice. In conclusion, it is very important for ESRD patients to know the importance of the renal diet and its benefits. Patients can gain more benefit from proper dietary guidance and management.