Patient engagement and safety mediated by self-efficacy: a cross-sectional study from Malaysian hospitals

Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia

Proton pump inhibitors (PPIs) are widely prescribed in hospital settings. Several reports have highlighted concerns about the inappropriate use of PPIs as stress ulcer prophylaxis (SUP) in patients outside the intensive care unit (ICU) setting. Little is known about this phenomenon in Malaysian hospitals. This study aimed to evaluate the appropriateness of PPI prescribing as SUP for patients admitted to the general medical wards of a Malaysian tertiary hospital and to determine the rate of unnecessary prescription of PPI for discharged patients. This was a retrospective cross-sectional study conducted in a tertiary hospital in Pahang, Malaysia. We reviewed the information held on electronic databases for patients admitted to the general medical wards from January to September 2019. Appropriateness of PPI prescribing was assessed using the criteria for SUP from predefined clinical guidelines. Of 660 screened patients admitted to the general medical wards, 200 were prescribed PPIs as SUP. Oral pantoprazole was the most frequently prescribed PPI (51.5%). Only 61 (30.5%) PPIs were prescribed according to current recommendations for the use of PPI for SUP. Sex, age, number of medications, length of hospital stay, and receiving PPI at discharge were not significantly associated with appropriateness of PPI prescribing. Half of the patients continued receiving PPIs at discharge without a documented indication. Our findings indicated a high prevalence of inappropriate prescribing of PPIs as SUP for non-ICU patients. Interventions to reduce the unnecessary use of PPIs in Malaysian hospital settings are desperately required. The need for national criteria that address the proper indications and dosing regimens for PPIs as SUP in ICU and non-ICU patients is high.

BackgroundPreterm birth (PTB) is defined as neonates that are born alive >22 weeks of gestation and <37 weeks of gestation. Because of the immaturity of different organ systems, 14.84 million newborns worldwide are born prematurely, which is the largest contributing factor to mortality and morbidity. Although studies have been conducted in this field, the magnitude of PTB is a major issue in most developing countries including Malaysia.ObjectiveTo assess the prevalence of PTB and the perinatal outcome among women delivered in a tertiary university hospital in Malaysia. MethodsThis was a cross-sectional study evaluating all singleton live births weighing>500g and delivered at >22+1 weeks of gestation between January 2015 and December 2019 in Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Data were collected from the hospital's recorded birth registry. The primary outcome was the PTB rate. Data were entered and analysed using Statistical Product and Service Solutions (SPSS) (version 28.0; IBM SPSS Statistics for Windows, Armonk, NY).ResultsA total of 26,022 singleton live births were reported for the period 2015-2019. PTB rates showed a sharp 6% decrease from 2015 to 2016, after which the trend was inconsistent until 2019. The risk of preterm babies being admitted to the neonatal intensive care unit (NICU) or the ward compared to the risk of neonatal mortality increases for babies of identified sex, delivered via caesarean, and with a birth weight between 2 and 3 kgs. Babies born at a gestational age between 22+1 and 33+6 have a higher risk of neonatal mortality compared to late preterm babies.ConclusionsThe PTB incidence trend was inconsistent from 2015 to 2019 in a tertiary university hospital in Malaysia, with a far higher prevalence compared to national data. The high NICU admission and mortality rates among preterm infants mean urgent strategies and policies are needed to improve perinatal outcomes.

The emergency medicine (EM) pharmacist is an integrated part of the Emergency Department (ED) interdisciplinary team in many countries, including Malaysia. The presence of EM pharmacists in the ED has positively impacted patient outcomes. Data on EM pharmacists' interventions is scarce in the Asian region. In Malaysia, data on interventions done by EM pharmacists in the EDs was unavailable. This study aimed to assess the type of interventions done by EM pharmacists in the ED of tertiary public hospitals in Malaysia. This cross-sectional, multicenter study involved EM pharmacists from 14 tertiary hospitals in Malaysia. All accepted interventions done by EM pharmacists in the ED for patients admitted to the Red (critical) and Yellow (semi-critical) zones from January to June 2022 were extracted from the Clinical Pharmacy Report Form. All data were analyzed descriptively. The EM pharmacists documented 1659 accepted interventions on 1584 patients during the study period. Inappropriate regimens (n = 1117, 67.3%) and incomplete prescriptions (n = 339, 20.4%) were the main categories of accepted interventions in ED. Inappropriate drug (n = 574, 34.6%), dose (n = 292, 17.6%), and frequency (n = 176, 10.6%) were the top three subcategory interventions documented under inappropriate regimens. Antimicrobials, antihypertensives, and proton pump inhibitors were the commonest drug intervened under the categories of inappropriate drug intervention. There were 272 (16.4%) accepted interventions on high-alert medications (HAMs). Insulin, enoxaparin, and noradrenaline were the most intervened HAMs. Inappropriate treatment regimens were the most common intervention category done by EM pharmacists in Malaysia. The significant number of interventions done by EM pharmacists demonstrated the importance of EM pharmacists as integral members of the EM team. This data can help improve the quality of clinical pharmacy services in the ED and is important for the future expansion of clinical pharmacy services in all EDs across Malaysia, neighbouring countries, and other developing countries.

Malaysia is an upper-middle-income country with national antimicrobial stewardship programs in place. However, hospitals in this country are faced with a high incidence of multidrug-resistant organisms and high usage of broad-spectrum antibiotics. Therefore, this study aimed to use a standardized audit tool to assess clinical appropriateness, guideline compliance, and prescribing patterns of antimicrobial use among medical patients in two tertiary hospitals in Malaysia to benchmark practice. A prospective hospital-wide point prevalence survey was carried out by a multidisciplinary team in April 2019 at the University Malaya Medical Centre (UMMC) and the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia. Data was collected from the patient's electronic medical records and recorded using the Hospital National Antimicrobial Prescribing Survey toolkit developed by the National Centre for Antimicrobial Stewardship, Australia. The appropriateness of prescriptions was 60.1% (UMMC) and 67% (HCTM), with no significant difference between the two hospitals. Compliance with guidelines was 60.0% (UMMC) and 61.5% (HCTM). Amoxicillin-clavulanic acid was the most commonly prescribed antimicrobial (UMMC = 16.9%; HCTM = 11.9%). The appropriateness of antimicrobial prescribing in medical wards, compliance with guidelines, and prescribing patterns were similar between the two hospitals in Malaysia. The survey identified several areas of prescribing that would need targeted AMS interventions.

Blood cultures contamination is a common scenario in Malaysian hospitals. Reducing the contamination rate of blood culture will reduce false-positive blood culture, prevent inappropriate antibiotic prescription and reduce patient management cost. This is a 6 months study specifically focused on the effects of changing the type of skin antiseptics used (70% isopropyl alcohol plus 2% chlorhexidine replacing 70% isopropyl alcohol plus povidone-iodine) and improving the knowledge and techniques of blood culture taking in a tertiary hospital. the remedial measures introduced were successful in achieving 4.34% contamination rate, which is 2.03% less than pre-remedial contamination rate (6.37%). There was a statistically significant reduction in the number of contaminants (p = 0.02) with five-fold rise in the significant blood cultures results. Better choice of skin antiseptics and good blood culture knowledge and technique may contribute to reduce number of contamination rate in blood culture.

Objective: To assess the prevalence of diabetic vascular complications and cardiovascular risk factors control in type 2 diabetic patients at tertiary settings. Methods: This cross-sectional study was conducted among 313 patients diagnosed with type 2 diabetes mellitus (T2DM) at two tertiary referral hospitals in Malaysia. Data regarding socio-demographics, macro- and microvascular complications, family health history, blood pressure, anthropometric indices, glycaemic control, and lipid profile were obtained from medical records, face-to-face interview and physical examination. Results: The mean age of patients was 55.7±9.2 years, mean diabetes duration was 10.1±8.1 years, and 52.1% were females. Approximately 36.1% patients had cardiovascular disease (CVD). There were high prevalence of established coronary artery disease (30.7%), cerebrovascular disease (10.2%), and peripheral vascular disease (5.1%). Peripheral neuropathy, diabetic nephropathy and retinopathy were present in 41.5%, 17.6% and 15.0% patients respectively. Only 14.1% of the patients reached optimal HbA1c level and 21.1% patients achieved target fasting plasma glucose. The overall prevalence of dyslipidemia was 89.1%, hypertension was 80.2%, and obesity was 35.9% (BMI) and 86.5% (waist-to-hip ratio). Conclusions: Diabetic vascular complications were highly prevalent among the type 2 diabetic patients. Cardiovascular risk factors control was suboptimal. Both awareness and application of recommended guidelines need to be reinforced.

Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by partial or complete obstruction of the upper airway, which causes desaturations and arousal. Various studies have shown that OSA is a major modifiable risk factor for hypertension. Untreated OSA is increasingly associated with cardiovascular and neurocognitive sequela. Thus, our study aims to determine the high-risk of obstructive sleep apnea among hypertensive patients at a tertiary care hospital in Malaysia. Methods: A cross-sectional study was conducted among hypertensive patients at a tertiary hospital in Malaysia. A validated Malay version of the Berlin Questionnaire was utilized along with other questions on sociodemographic characteristics and diabetes mellitus. Results: A total of 161 respondents were involved in the study. The mean age was 48.35 years and among these 75% were males and 25 % were females. The majority of respondents were of Malay ethnicity (78%), followed by Chinese (11%) and Indians (10%). Of these,18 % comprised of obese patients and 29.8% had diabetes mellitus. The prevalence of high-risk OSA among hypertensive patients was 18.0% (95% CI). High risk of OSA was found to be prevalent in the elderly age group (p&lt;0.001), female gender (p&lt;0.001), Indian ethnicity (p&lt;0.001) and among diabetes mellitus patients (p&lt;0.001). Conclusion: The study results illustrate the high risk of OSA among hypertensive patients with advancing age and diabetes mellitus. This study finding mandates these high-risk hypertensive patients should be screened for early diagnosis and timely treatment of OSA to prevent further cardiovascular risk, morbidity and mortality.

Objective: To determine the prevalence of group B Streptococcus (GBS) isolated from non-pregnant adults from seven major hospitals in Peninsular Malaysia; the incidence, case-fatality ratio, antimicrobial susceptibility patterns, serotype, genotype and distribution of the GBS virulence and pili genes are also investigated. Methods: This multicentre, prospective, observational study is conducted in seven major tertiary hospitals in Malaysia among non-pregnant adults. Simultaneously, a retrospective study is conducted in the selected hospitals with similar approaches. GBS isolates are subjected to phenotyping, serotyping by multiplex PCR, antimicrobial susceptibility testing and PCR-detection of GBS virulence and pilus genes. Seven housekeeping genes are amplified and sequenced for multi-locus sequence typing. Discussion: Findings from the study may contribute to the management of clinical practice to diagnose and prevent GBS related diseases in a timely manner. Prudent use of antibiotics is encouraged by monitoring antimicrobial resistance.

BackgroundThe universal newborn hearing screening (UNHS) has effectively allowed babies with hearing loss to be detected early. However, findings from previous studies indicate that this procedure may adversely induce anxiety among mothers. Therefore, this study aimed to investigate anxiety among mothers whose babies received a hearing screening at a tertiary hospital in Malaysia. A cross-sectional study was conducted on 105 mothers from a tertiary hospital in Kuala Lumpur, Malaysia. Two questionnaires, the Infant Health Concern Scale (IHCS) and State-Trait Anxiety Inventory (STAI), were used to measure the mothers’ worry level on a 4-point Likert scale. Mothers were required to complete the questionnaires twice, before and 4 weeks after discharge, regardless of the hearing screening results.ResultsThe STAI scores obtained from mothers whose babies failed the initial screening were significantly higher than mothers whose babies passed. During the initial screening, all mothers rated hearing as the sixth health aspect causing anxiety using the IHCS. However, the ranking fell to 15th place after the second screening. Similarly, mothers whose babies had false positive results also exhibited significantly higher STAI scores and a dropped hearing ranking during rescreening than the initial screening. In addition, mother’s anxiety was not significantly correlated with their education level, family income, or number of births.ConclusionMothers who participated in this study experienced anxiety regardless of their babies hearing screening results. Therefore, the UNHS program must be reviewed to identify appropriate strategies to minimize this negative emotion among mothers.

Prescribing medicines in an unlicensed and off-label manner for children is a widespread practice around the world. To determine the extent and predictors of off-label respiratory drug prescriptions for children in the outpatient clinics of a hospital in Malaysia. Outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre, a tertiary teaching hospital in Malaysia. The pharmacy-based computer system and medical records of the patients were utilized to collect data from 220 pediatric patients who were prescribed at least one respiratory drug from July 2011 to December 2011. Characteristics of the off-label respiratory drug prescriptions were measured. A total of 134 children (60.9 %) received at least one respiratory drug prescribed in an off-label manner. The most common reasons for the off-label prescribing of drugs were off-label use by indication (31.5 %), followed by higher than the recommended dose (24.9 %) and lower than the recommended frequency (17.1 %). Diphenhydramine was the most common respiratory drug prescribed off-label. The number of medications prescribed was the only significant predictor of off-label prescription of respiratory drugs. Pediatric patients receiving 4-6 medications were 7.8 times more likely to receive at least one off-label respiratory drug compared to pediatric patients that received 1-3 medications (OR 7.8, 95 % CI 1.74-37.44). There was substantial prescribing of respiratory drugs for children in an off-label manner at the outpatient clinics at the Universiti Kebangsaan Malaysia Medical Centre. This highlights the need for more research to be carried out on respiratory drugs in the pediatric population.

There is limited information regarding the prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery in South East Asia. The primary objective was to assess the prevalence of extracranial carotid stenosis, raised carotid intima media thickness (CIMT), and plaques in the patients with CAD undergoing elective CABG. The secondary objective was to evaluate the risk factors for extracranial carotid atherosclerosis.A total of 119 consecutive patients with CAD undergoing elective CABG in a tertiary hospital in Malaysia were recruited. Data on the demographic characteristics and risk factors were collected. The ultrasound carotid Doppler findings comprising of raised CIMT, plaques, and stenosis in the extracranial carotid vessels were recorded.The mean age of the patients was 64.26 ± 10.12 (range 42–89). Most of the patients were men (73.1%). The patients consisted of 44 (37%) Malays, 26 (21.8%) Chinese, and 49 (41.2%) Indians.A total of 67 (56.3%) patients had raised CIMT, 89 (74.8%) patients had plaques, and 10 (8.4%) patients had stenosis in the internal and common carotid arteries. The mean age of patients with plaques was higher compared to those without plaques (66.00 ± 9.63 vs 59.10 ± 9.92, P = .001). The body mass index (BMI) of patients with stenosis was higher compared to those without stenosis (28.35 ± 4.92 vs 25.75 ± 3.16, P = .02).The patients with plaques were more likely to be older, whereas the patients with carotid stenosis were more likely to have higher BMI.

Background: Atherosclerosis, a chronic inflammatory condition of the arterial intimal wall projected globally to impact healthcare significantly. The pattern of atherosclerosis, namely the atherosclerotic disease and atherosclerotic risk, may or may not be the reason for hospitalization; nevertheless, they have ongoing atherosclerosis that may progress over the years. Studies have shown that both patterns of atherosclerosis play an essential role in conferring poor prognosis and contributing to the leading cause of death. We embark on a study to analyze the socio-demographic and pattern of atherosclerosis of adult patients without SARS-Cov-2 infection admitted to a new tertiary hospital in Malaysia. We exclude patients who are predicted to have a high possibility of death or discharge within 24 hours, lactating mothers, oncology patients and non-Malaysian citizens; Methods: This prospective cross-sectional study recruited general medical and surgical ward adult patients between 9th October and 1st January 2021. The data were collected using face-to-face interviews with the patients and from the medical records. For our research, we identify the patient’s affirmation on having atherosclerosis, atherosclerotic disease, atherosclerotic risks, the reason for admission and their discharge outcome.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

BackgroundAddressing breast cancer patients’ unmet supportive care needs in the early stage of their survivorship have become a prime concern because of its significant association with poor quality of life (QOL), which in turn increases healthcare utilization and costs. There is no study about unmet supportive care needs of breast cancer patients in Malaysia. This study aims to assess the most prevalent unmet supportive care needs of Malaysian breast cancer patients and the association between QOL and patients’ characteristics, and their unmet supportive care needs.MethodsA cross-sectional study was conducted at the Surgery and Oncology Clinic between May 2014 and June 2014 in a tertiary hospital in Malaysia. A total of 117 patients out of 133 breast cancer patients recruited by universal sampling were interviewed using a structured questionnaire consisted of three parts: participants’ socio-demographic and disease characteristics, Supportive Care Needs Survey-Short Form Questionnaire (SCNS-SF34) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30).ResultsThe highest unmet supportive care needs were observed in the psychological domain (Mean 53.31; SD ± 21.79), followed by physical domain (Mean 38.16; SD ± 27.15). Most prevalent unmet supportive care needs were uncertainty about the future (78.6 %), fears about the cancer spreading (76.1 %), feelings of sadness (69.2 %), feelings about death and dying (68.4 %), concerns about those close to the patient (65.0 %) and feeling down or depressed (65.0 %). Multivariate linear analysis showed that early breast cancer survivors diagnosed at an advanced stage and with greater physical and psychological needs were significantly (p < 0.05) associated with poorer QOL.ConclusionMost prevalent unmet needs among Malaysian breast cancer patients were found in the psychological domain. Early breast cancer survivors with late stage diagnosis who had more unmet needs in psychological and physical domains were more likely to have a poor QOL.