Lung cancer through patients' lived experiences: A sociocultural perspective.

BackgroundAgainst the backdrop of systemic inefficiency in the public health care system and the theoretical claims that markets result in performance and efficiency improvement, developing countries’ governments have been rapidly commercializing health care delivery. This paper seeks to determine whether commercialization through an expansion in private hospitals has led to performance improvements in public hospitals.MethodsInpatient utilization records of all public hospitals in Peninsular Malaysia over the period 2006–2010 were used in this study. These records were obtained from the Ministry of Health. The study relied on utilization ratios, bed occupancy rates (BOR), bed turnover rates (BTR) and average length of stay (ALOS). The data were analyzed using SPSS 22 Statistical Software and the Pabon Lasso technique.ResultsOver 60 % of public hospitals in Malaysia are inefficient and perform sub-optimally. Average BOR among the public hospitals was 56 % in 2006 and 61 % in 2010. There was excessive BTR of 65 and 73 times within the period. Overall, the ALOS was low, falling from 3.4 days in 2006 to 3.1 days in 2010.ConclusionsThis study demonstrates that commercialization has not led to performance improvements in the public health care sector in Malaysia. The evidence suggests that efforts to improve performance will require a focus directly on public hospitals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0131-y) contains supplementary material, which is available to authorized users.

Parking in public hospitals has been a significant issue for public, authorities and parking operators running the facility within the hospital compound. In view to the fact that private vehicles are the preferred mode of choice for commuting in Malaysia, the issue could not get any better. This paper attempts to evaluate parking characteristics in public hospitals in Malaysia. Parking characteristics at six public hospitals in Peninsular Malaysia were investigated. Secondary data were obtained from Ministry of Health. License Plate methodwas used to collect parking demand data as a primary data for a period of 12 hours at public hospitals.Parking duration, parking turnover and parking index were determined to investigate parking scenario at each respective study sites. It was found that long parking hours was a nature in public hospitals with average parking duration of almost 4 hours/veh. Higher parking turnover rate was also observed for public bay area. The average parking index for all hospitals was also more than 100% in which it exceeding the capacity. The actual parking demand was found to be higher than the provided parking space at all public hospitals under investigation and it is also far below the specified various guidelines except for EPU guideline.

Patient satisfaction on the utilization of traditional and complementary medicine services at public hospitals in Malaysia

Methods This study was designed to assess and review current practice and policy in the Malaysia pharmaceutical procurement procedures of non-formulary medicines. This was a quantitative study and was conducted in a cross-sectional study design. A purposive sampling method was applied in the study sample selection. The targeted samples to be involved in the selection were the public healthcare institutions in Malaysia. The study was conducted in the 13 major public hospitals in Malaysia. The data and information on the pharmaceutical procurement of nonformulary medicine management, financial allocation and expenditures on pharmaceuticals purchased in the selected facilities for the three consecutive years of 2011, 2012 and 2013 were collected and analysed statistically. The study has been conducted over a year. The study was carried out from February 2014 until February 2015. The study has been carried out in the major public hospitals in Malaysia focusing both on the out-patient and in-patient sectors.

The aim of this study is to identify the factors of loyal patients in public hospitals in Malaysia. The influence of service quality on patient satisfaction and the indirect relationship between service qualities attribute, patient satisfaction and patient loyalty are evaluated. A quantitative research is conducted with close ended questionnaire as an instrument to collect the responses from outpatient centers of public hospital in Malaysia. The results were estimated by using SPSS and Amos 23 to evaluate the relationship between the proposed constructs. The findings highlighted the importance of loyalty in medical care. The factors leading to loyalty are identified and the relationship between satisfaction and loyalty is reconfirmed as prior documented studies.

Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients’ journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.

The purpose of this study is to explore the determinants of telemedicine acceptance in selected public hospitals in Malaysia and to investigate the effect of health culture on the relationship between these determinants and telemedicine acceptance. Data were gathered by means of a survey of physicians and nurses as the main group of users of telemedicine technology from hospitals that are currently using telemedicine technology. The results indicated that government policies, top management support, perception of usefulness and computer self-efficiency have a positive and significant impact on telemedicine acceptance by public hospitals in Malaysia. The results also confirmed the moderating role of health culture on the relationship between government policies as well as perceived usefulness on telemedicine acceptance by Malaysian hospitals. The results are useful for decision-makers as well as managers to recognize the potential role of telemedicine and assist in the process of implementation, adoption and utilization, and, therefore, spread the usage of telemedicine technology in more hospitals in the country.

Purpose Breast cancer is the most common form of cancer among women in Malaysia. Although there is a scarcity of data on the relation between delays and survival, it is generally accepted that optimum outcomes are dependent on the early detection and adherence to treatment. This study was conducted to evaluate the time intervals and associated factors with delays in presentation, diagnosis, and treatment among patients with breast cancer who attended public hospitals in Malaysia. Methods A retrospective cohort study was conducted in six public hospitals involving all patients with newly diagnosed breast cancer from January 1, 2012, to December 31, 2012. Data were collected through review of medical records and interviews using a structured questionnaire. Presentation delay was defined as time taken from the discovery of symptoms to the first presentation at primary care of more than 3 months. Diagnosis delay was defined as time taken from the first presentation to diagnosis disclosure of more than 1 month, and treatment delay was defined as time taken from diagnosis disclosure to initial treatment of more than 1 month. We used univariable logistic regression and multiple logistic regressions for analysis. A total of 340 patients with breast cancer were included in the study. Median times for presentation, diagnosis, and treatment were 2.4 months, 26 days, and 21 days, respectively. The presentation delay rate was 35%, and the factors associated with it were location (Kelantan: odds ratio [OR], 4.78) and use of complementary and alternative medicine (OR, 1.67). The diagnosis delay rate was 41.8%, and the factors associated with it were symptoms without lump (OR, 1.98), undergoing two or more biopsies (OR, 3.02), and surgical biopsy (OR, 2.56). Meanwhile, the treatment delay rate was 35.3%, and the factors associated with it were location (Johor: OR, 4.95; Kelantan: OR, 6.68; and Sarawak: OR, 3.88) and those diagnosed at other hospitals (OR, 2.18). Results Delays in presentation, diagnosis, and treatment were high among patients with breast cancer who attended public hospitals in Malaysia. Factors that influenced delays were locality, socio-culture, patients, and health systems. Mutual collaboration involving patients and health care sectors and a comprehensive intervention study are suggested to improve the quality of breast cancer care in Malaysia. Conclusion Delays in presentation, diagnosis, and treatment were high among patients with breast cancer who attended public hospitals in Malaysia. Factors that influenced delays were locality, socio-culture, patients, and health systems. Mutual collaboration involving patients and health care sectors and a comprehensive intervention study are suggested to improve the quality of breast cancer care in Malaysia. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Background: The role of breast cancer treatments in reducing recurrence and death has been established. However, the treatments side effects greatly impact on quality of life and little is known about the non-adherence rates. The purpose of this study was to determine the non-adherence rates to surgery, chemotherapy, radiotherapy and hormonal therapy, and factors that affect it in public hospitals in Malaysia. Methods: A multicentre cross-sectional study was conducted in six public hospitals involving all newly diagnosed breast cancer patients in 2012. Data were collected through medical record reviews and interview by using structured questionnaire. Non-adherence was categorized as any breast cancer patients refusing or discontinuing any treatment due to non-medical reasons. Univariable logistic regression and multiple logistic regressions were used for analysis. Results: A total of 340 breast cancer patients were included in the study. The proportion for non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy were 14%, 30.1%, 33.3% and 36.3% respectively. Factors associated with non-adherence to surgery were localities involving Kuala Lumpur (2) (OR: 3.41), Johor (OR: 8.38) and Kelantan (OR: 6.32), and those required mastectomy (OR: 5.66). No factors were found to be associated with non-adherence to chemotherapy, radiotherapy and hormonal therapy. These three treatment modalities were then combined as oncology therapy and the only independent factor associated with non-adherence to oncology therapy was Perak locality (OR: 1.42). Conclusion: Non-adherence to breast cancer treatments was high among breast cancer patients at public hospitals in Malaysia. Factors influencing non-adherence were locations and mastectomy implicating of socio-culture, body image issues, psychological disturbance and treatment navigation. Community educational programs focusing on correcting misconceptions, treatment outcomes and treatments’ side effects would reduce non-adherence and improve the quality of breast cancer care in Malaysia. NMRR ID: NMRR-12-910-10919

This paper was written to give a clear picture about the importance of utilizing quality assurance tools to ensure high healthcare professionals' performance in one of the well-known public hospitals in Malaysia. Improving quality among healthcare professionals has become a unifying theme across any hospitals in Malaysia. The importance of improving performance was seen in growing attention to patient safety and reducing medical errors as well as seen as an attempt to reduce waste and inefficiency in the health sector. The rapid growth in healthcare industry in terms of number of competitors as in private medical centers and facilities has also led leaders to ensure their healthcare professionals have derived their performance to full limits. The objective of this paper was to identify the tools that gave the biggest impact towards healthcare professionals' performance and the outcome after complying with the whole quality assurance practice. Respondents selected were doctors and medical officers in Universiti Malaya Medical Centre (UMMC). The result of this paper showed that the three quality assurance tools identified were really critical to ensure the success of the healthcare professionals' performance. The organization and healthcare professionals must play their roles and support each other in enforcing the quality assurance practices to produce good result in meeting their standards and objectives. The application of quality assurance practices was really necessary for both organization and healthcare professionals in order create competitive advantage and to survive in the healthcare industry.

The public healthcare system in Malaysia was established in the 1850s, prior to the country's independence. Today, it encompasses 146 public hospitals to provide affordable and accessible healthcare services to all Malaysian citizens. However, the public healthcare sector faced various challenges, including ageing facilities and infrastructures, deferred maintenance, limited accessibility, and inefficient layouts. This paper presents a comprehensive approach in designing public hospitals in Malaysia, with a focus on addressing the healthcare needs of the population and improving healthcare infrastructures through architectural optics. This article explores key aspects of hospital designs, including architectural considerations, functional requirements, technological integration, and compliance with regulations and relevant acts. Eight expert samples were employed through semi-structured interviews to ensure credibility and validity. This methodology allowed flexibility in questioning and yet tailored exploration of relevant issues and expertise. Clear data sources and research objectives were established to minimize potential bias and limitations. By incorporating patient-centric design principles, enhancing accessibility, promoting sustainability, and considering future scalability, the proposed design aims to improve public hospitals that can effectively meet the healthcare demands of Malaysia. The recommendations outlined in this study can serve as a guideline for policymakers, healthcare authorities, and designers involved in the creation of efficient and effective healthcare facilities.

INTRODUCTIONObesity in Malaysia has reached an alarming rate and various treatment modalities are available for patients depending on the severity of their obesity. Bariatric surgery has been proven to be part of the armamentarium to combat obesity; however, only a few public hospitals in Malaysia are capable of providing such a niche service. This study reports our experience over the past 3 years in a long-standing multidisciplinary bariatric clinic that was established in 2014 and based in a public hospital. METHODOLOGYRetrospective analysis of a prospectively maintained database of all patients undergoing bariatric surgery from January 2021 until April 2024 was performed. We analysed patient demographics, comorbidities and peri-operative complications. Prior to surgery, patients are thoroughly assessed, management of comorbidities is optimised, and the type of procedure and its expected outcomes are discussed in detail. Patients are required to be placed on an outpatient-based very low-calorie diet (VLCD) from 10 to 14 days prior to surgery. Peri-operative deep vein thrombosis prophylaxis is generally practiced unless contraindicated. RESULTA total of 125 patients underwent various bariatric procedures (75 sleeve gastrectomies, 40 Roux-en-Y gastric bypasses, 7 sleeve plus procedures, and 3 revisional procedures) with a mean age of 39.5 years and a mean BMI of 49.1 kg/m2 . The percentage of patients with diabetes, hypertension, and dyslipidaemia was 28.8%, 50.4% and 32% respectively. One patient was excluded as she required a conversion back to normal anatomy after gastric bypass. Throughout the study period, 3 major complications (Clavien-Dindo Grade III and above) were observed and 2 patients required readmission within one month due to dehydration. CONCLUSIONThis study shows that a multidisciplinary team with sufficient training and experience can provide bariatric surgery within a constrained public health system.

Purpose This study investigates the relationship between five service quality dimensions: communication, courtesy, emotional support, hospital amenities and understanding of needs and the satisfaction of patient companions in Malaysian public hospitals during the COVID-19 pandemic. Design/methodology/approach This study employed a quantitative research approach, utilizing a structured questionnaire to survey 260 respondents in Malaysian public hospitals. The questionnaire was designed to assess respondents’ perceptions of service quality dimensions, measure their satisfaction with public hospital services and gather demographic and background information. The data underwent validation factor analysis to ensure the reliability and validity of the measurement model. Additionally, structural equation modeling (SEM) was conducted to evaluate the strength and significance of the relationships between the variables. Findings The study findings revealed that emotional support, courteous behavior, hospital amenities and responsiveness to companions’ needs in Malaysian public hospitals were positively associated with companion satisfaction. Additionally, communication was found to have a significant and negative impact on companion satisfaction. Originality/value By integrating emotional, behavioral and infrastructural elements into the SERVQUAL model, this study addresses the often-overlooked perspective of patient companions. It offers actionable insights for improving public hospital service quality in pandemic and post-pandemic contexts.

Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory study among public hospitals in Malaysia

A Prospective Study of Surgical Site Infection in Elective and Emergency General Surgery in a Tertiary Public Hospital in Malaysia - A Preliminary Report