Government Hospitals In Malaysia Research Articles

The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial.

Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia. This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia. This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ≥18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress. The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70%) caregivers are women and 30 (30%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained. It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up. Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286. RR1-10.2196/53692.

Quality of Work Life among Nurses in Malaysia Government Hospital

Globally, nurses in the health care system have affected the quality of work life due to dynamic changes in the work environment. This study assesses nurses' quality of work life in government hospitals. A cross-sectional study was conducted among 1008 nurses who worked at five government hospitals in Malaysia. The respondents had almost similar results, with 50.1% of the respondent being satisfied with QoWL. The nurse's quality of work-life is at a moderate level. The health care authorities should implement policies to strengthen the operational standards so that nurses can provide excellent and effective patient care.

Patient-Friendly Information Giving in HIV Counselling through the Use of Metaphors

HIV counselling is a method of communication between patients and certified HIV nurse counsellors to discuss and help patients deal with HIV-related issues. Despite the training received by these nurses, communicating HIV-related issues remains a difficult task in Malaysia. Due to lack of research examining information giving in HIV counselling in Malaysia, this study investigated both the challenges and the strategies in providing information to HIV patients. Twenty-four audio recordings of actual HIV counselling sessions were gathered and six focus group discussions with HIV nurse counsellors from three government hospitals in Malaysia were recorded. The discourse analysis of revealed a prominent use of metaphors as part of information giving strategies to overcome the challenges faced by HIV nurse counsellors when communicating with HIV patients. The metaphors were embedded in HIV nurse counsellors’ information giving to HIV patients and their spouse/family as a way to represent some medical jargons pertaining to HIV. Since the HIV patients came from different educational background, it would be much easier for them to understand HIV-related information giving through the use of metaphors. Therefore, the acknowledgement and integration of metaphors can be an amazingly valuable tool for HIV nurse counsellors especially in managing the communication challenges during HIV counselling. It is hoped that the findings provided in this study will serve as a basis for integrating metaphors into counselling practices.

Drug Utilisation Evaluation of Human Albumin Solution in Tawau Hospital, Sabah, Malaysia

Human albumin solution (HAS) which is available in government hospitals in Malaysia, mostly are supplied by the National Blood Centre, Ministry of Health (MOH) Malaysia. Due to the high usage of HAS, it is a strain to meet the demands nationwide. Moreover, HAS is very expensive. This study was a retrospective observational study evaluating drug utilisation of HAS in Hospital Tawau, Sabah. A name list of 61 patients who had received HAS between 6 months from 1 January to 30 June 2019 was sent for medical records tracing. Forty-eight prescriptions of HAS were evaluated and later categorised as ‘proven indications’ or ‘unproven indications’ with the aid of an internally prepared guideline. The result of this study indicates that 12 (25%) out of 48 prescriptions were for ‘unproven indications’. Possible wastage due to ‘unproven indications’ was 29 vials which were 20% of the total HAS usage in this study, estimated to cost RM7,804 (USD1,880). Major surgery with a serum albumin level of 20 g/L and above (55.2%), paracentesis with ascitic fluid removed of less than 5 L (24.1%) and hypoalbuminemia without justified comorbid or diagnosis (20.6%) being reasons for possible wastage of HAS in this study. The percentage of possible wastage of HAS reflected in this study was not as high as other published research done in other countries, mainly due to additional steps required for prescribing HAS in our facility (filling Blood Plasma Product Request Form) and also the need to obtain approval from the Director-General of MOH Malaysia if it was prescribed for other than the approved indications.

An Intensive Care Nurse Narrative of Spiritual Care During COVID-19

Introduction: The intensive care management during the pandemic of COVID-19 is highly critical. The provision of spiritual care to the patients and their family members is important but challenging to be accomplished during this time. This article attempts to provide a view of an intensive care nurse’s experience of spiritual care during the COVID-19 pandemic.Methods: Interview was conducted with a nurse who worked in an intensive care unit (ICU) of a tertiary government hospital in Malaysia. It is a part of a larger qualitative study investigating the perceptions of ICU clinicians in providing spiritual care in the ICU. A thematic analysis was utilized in identifying emergent themes that would be significant in context of intensive care COVID-19 management. Results: There were two emergent themes that were identified from the nurse’s reflection – Keeping faith, and Blessed outcomes.Conclusion: This reflective account of a nurse providing spiritual care in the ICU may give insights for a better COVID-19 management. Further research is needed to explore the use of reflective practice in the spiritual care education and training. Further studies should also include the experience of the patients, the families as well as the professionals in the ICU to develop a concise model of spirituality and spiritual care in the ICU context, particularly during the pandemic of COVID-19.

Psychiatric pharmaceutical care service across Malaysian hospitals: results from a cross-sectional study

BackgroundPsychiatric pharmaceutical care is the provision of pharmaceutical care services to patients with psychiatric related illnesses or disorders. Several studies have demonstrated the positive influence psychiatric pharmaceutical care on patients’ clinical, humanistic and economic outcomes. This study aimed to examine the extent of psychiatric pharmaceutical care practice in a convenience sample of Malaysian government hospitals and the barriers to the provision of these services.MethodsAn anonymous cross-sectional survey of registered pharmacists working at a convenience sample of government hospitals in Malaysia was undertaken from September 2019 to June 2020.ResultsPharmacists frequently ensured the appropriateness of the dose (55%), dosage form (47%) and dosing schedule (48%) of the dispensed medications. Most pharmacists infrequently worked with patients and healthcare professionals to develop a pharmacotherapeutic regimen and a corresponding monitoring plan (28%). There was no statistically significant difference in the provision of pharmaceutical care services with respect to gender, age, years of practice, and professional board certification. However, the services offered were influenced by the respondent’s education and pharmacy setting. The obstacles perceived by pharmacists included lack of time (89%), shortage of pharmacy staff (87%), the patients’ inability to comprehend medical information (85%), insufficient demand and acceptance by patients (82%), the lack of official policies and standardised practice protocols (78%), inaccessibility to the patients’ medical records (77%) and the lack of structured communication channels between pharmacists and physicians (75%), the pharmacists lack of knowledge/skills and confidence (78%) and insufficient recognition from physicians to the pharmacists’ skills (76%).ConclusionsThis is the first study to explore the extent and barriers of psychiatric pharmaceutical care in Malaysian hospitals; it highlighted the need for mobilising pharmacists to expand these services.

Importance and Performance of Value-Based Maintenance Practices in Hospital Buildings

After two decades of privatization of building maintenance service in government hospitals in Malaysia, evidence of under-maintained hospital buildings suggests a need to raise the level of hospital maintenance service delivery. This study identified the critical success factors to enhance the value outcomes of hospital maintenance service. A total of 66 questionnaire survey responses from maintenance personnel in public hospitals were analyzed using the Importance-Performance Matrix Analysis (IPMA) in the SmartPLS3.0 software. The Importance versus the Performance of value-based practices was mapped to identify the critical areas that require greater considerations to improve maintenance service delivery. The findings revealed four critical success factors: Responsive to Needs, Integrated Service Solutions, Innovative Improved Practices, and Value for Money. These practices were found to be the impetus that can bring significant enhancement to hospital building maintenance service delivery. Although the findings are based on data derived from public hospitals in Malaysia, the outcomes are applicable to private hospitals both in and outside of Malaysia.

Energy Star based benchmarking model for Malaysian Government hospitals - A qualitative and quantitative approach to assess energy performances

The hospital building's operation can be symbolised as high energy usage with different services provision and facilities. The energy performances for hospital buildings in Malaysia are often quantified using a simple Building Energy Intensity (BEI) as the indicator. However, this method has less accuracy on the building's performance due to complex energy systems and different sizes for hospital-built environments. Hereof, this study aims to establish an energy benchmarking indicator for government hospitals in Malaysia using the Energy Star score method. The actual large dataset of hospitals samples has been quantified, scrutinised and optimised using the multiple linear regression (MLR) analysis to identify specific parameters affecting the energy use. The proposed model found that the final output result had shown a good fit for all hospital datasets. Further classifications were conducted on hospitals according to their energy score and air-conditioned area (ACA) for ranking comparison and assessment. Subsequently, from the same benchmarking model, an energy benchmarking calculator was developed in order to assist hospitals in automatically assessing their energy performance and labelling. Therefore, better energy management practices and decisions may be suggested for the Malaysian hospital buildings' continuous improvement. The novelties for this study are the formulated benchmarking models by optimising significant parameters from the actual large dataset of Malaysian hospitals and the developed benchmarking calculator for the regulator and hospital use.

Perceived Competence as a Mediator in Parental Engagement in Speech Therapy

Parental engagement has been recognised as a critical factor in providing optimal speech therapy services to children. However, it continues to be challenging for clinicians to effectively engage parents in speech and language intervention for their children. Therefore, this study was conducted to investigate the roles of parental expectation and parent-therapist communication on parental engagement in speech therapy and to determine the contribution of the parent’s perceived competence as a mediator. A total of 389 respondents were selected from government hospitals in Malaysia for this cross-sectional study. Four instruments were administered: Parental Expectation Scale, Therapist-Parent Communication Questionnaire, Perceived Competence Scale, and Parent Home-programme Compliance Questionnaire. In addition, descriptive, bivariate, and mediation analyses were performed using SPSS and Smart-PLS software to address the study objectives. The results showed that perceived competence partially mediated the relationship between communication and expectation on parental engagement. Thus, it can be concluded that to ensure parental engagement in a child’s intervention which is vital for a better outcome. Parents need to be competent and believe strongly in their capabilities to practise in speech and language intervention. Moreover, policymakers and clinicians should focus on strategies that can improve parental expectations and communication.

Prevalence of Pap Smear among Female Health Personnel in Hospital Tuanku Ja’afar Seremban, Malaysia

Background: Cervical cancer is the third common cancer among women in Malaysia. Human papillomavirus is most prevalent among young women with early sexual activity, multiple partners, smoking, and immunosuppression. Screening for detection and early treatment is more effective for managing cervical cancer. Papanicolaou (Pap) smear test is used for the early detection of cervical cancer. The National Health and Morbidity Survey conducted in 2019 showed only 36.6% of women in Malaysia have undertaken the test. Method: A cross-sectional study was carried out from August 2019 to October 2019 in the hospital Tuanku Ja’afar (HTJ) a tertiary government hospital in Malaysia. The target population was female healthcare personnel, the self-administered questionnaire had been used for data collection. Data analysis was done using Statistical Package for Social Science It was including socio-demographic background, lifestyle, and knowledge towards Pap smear. Our objective is to determine the incidence of Pap smears between female health personnel in the hospital. Results: The prevalence of having Pap smear done once in their life was 55.7%, only 33.5% of them had it done within the past 3 years according to the guideline. Prevalence was significantly lower in the singles, younger age, doctors, higher educational level, and higher monthly income. The main factors for poor response were a busy schedule, having no unusual symptoms, personal shyness, and fear of pain.Conclusion: The prevalence of Pap smear among female health personnel in HTJ is not consistent with their knowledge of pap smear. Hence, reinforcement of pap smear screening is important to reduce the prevalence of cervical cancer by addressing obstacles and constraints for a good response among female healthcare personnel. Moreover, awareness of screening guidelines through media, health campaigns, and health talks will help to assure practice more effectively.

Development and Validation of a High-Performance Liquid Chromatography–Tandem Mass Spectrometry Method for Methotrexate Quantitation in Human Serum

Methotrexate (MTX) is the only chemotherapy drug that is routinely monitored by therapeutic drug monitoring service in Malaysia government hospitals. The patients with MTX plasma concentration exceeding 0.4 μM for 48 h are at higher risk to develop toxicities such as nephrotoxicity, hepatotoxicity, neurotoxicity, mucositis and myelosuppression. The aim of this study was to develop and validate the ultra-high performance liquid chromatography−tandem mass spectrometry (UHPLC−MS/MS) method for MTX quantitation in human serum. Our results show that the retention times of MTX and warfarin (internal standard) were 1.82 and 2.68 min, respectively. The linearity was obtained at the concentrations from 25 to 500 ng/mL with the regression equation of y = 1025x – 11757 and r2 of 0.9901. This analyte was stable in a freezer at –80°C for up to 90 days. As a conclusion, this UHPLC−MS/MS method is an optional technique for clinicians to quantitate the patient’s MTX levels in the hospital.

Emergency department discharge instruction for mild traumatic brain injury: Evaluation on readability, understandability, actionability and content

IntroductionEmergency departments (EDs) routinely provide discharge instructions due to a large number of patients with mild traumatic brain injury (mTBI) being discharged home directly from ED. This study aims to evaluate the quality of available mTBI discharge instructions provided by EDs of Malaysia government hospitals. MethodsAll 132 EDs were requested for a copy of written discharge instruction given to the patients. The mTBI discharge instructions were evaluated using the Patient Education Materials Assessment-Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established guidelines. Results49 articles were eligible for the study. 26 of the articles met the criteria of understandability, and 3 met the criteria for actionability. The average readability level met the ability of average adult. Most of the discharge instructions focused on emergency symptoms, and none contained post-concussion features. ConclusionMajority of the discharge instructions provided were appropriate for average people to read but difficult to understand and act upon. Important information was neglected in most discharge instructions. Thus, revision and future development of mTBI discharge instruction should consider health literacy demand and cognitive ability to process such information.

A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy.

BackgroundNon-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework.MethodsWe conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient’s illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ).Results208 patients participated in this study. The median age of the study participants was 35 years (IQR 26–44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19–4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38–6.24, p = 0.005) were significant contributors to non-adherence.ConclusionBeing employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.

The Provenance of Stress among Employees in Government Hospital in Malaysia

This study to identify the reasons for stress between employees in government hospital in Malaysia. The objective of this research is to measures the association between job enrichment, facilities and job satisfaction with provenance of stress and measure the predictor provenance of stress among employees in government hospital. Stress experienced at work can have adverse results for the prosperity of individual employees and association as entirety. This study is quantitative in nature and questionnaires distributed to gather information from respondents based on 150 sample size. The data obtained through questionnaires was analyzed and evaluated by statistical test correlation and regression. Most of the results show moderate and strong relationship on provenance of stress. Finally, limitation of study is also recognized and identified after the research is done. There are recommendations to the government hospitals and for future research to be conducted for better understanding in future.

Physicians intention to leave from malaysia government hospitals with existing retention strategy.

Background: Healthcare professionals or physicians are important assets for health institutions in ensuring optimum delivery of healthcare to the people. Job satisfaction in various aspects including daily tasks, responsibilities and other duties will indirectly provide high productivity to an organization as well as ensuring a conducive working environment and reducing the resignation rates. Resignation rate trends among physicians in Malaysia ranged from 6.4% in 2000 to 3.5% in 2016. The introduction of Full Paying Patient services in Ministry of Health hospitals in 2007 somewhat contributed to the reduction in resignation rate of physicians. The purpose of this research is to assess this retention strategy implemented in Ministry of Health in achieving one of its objectives (to retain physicians). The assessment will help gain a better understanding of the complexities involved to assist policymakers in establishing good policies and guidelines to reduce the rate of resignation among physicians in the government hospitals and ultimately ensure a sustainable national health system. Methods: This is a cross sectional study involving simple randomly sampled physicians from the daily attendance list in pioneered Ministry of Health hospitals offering Full Paying Patient services. The study using quantitative methods in the form of structured questionnaires that are often used to measure the level of job satisfaction (Minnesota Satisfaction Questionnaire-short form). Results: Intention to leave found in 46.8% of respondents though the findings of this study do not statistically significant (p value of 0.437) which indicates that there are other factors involve. However, job satisfaction towards governance and work processes at workplace are turned out to be associated with intention to leave among physicians in Malaysia government hospitals (p value less than 0.05). monitoring of its effectiveness together with research on factors that motivate health workers in order to Conclusions: Full Paying Patient services must be accompanied by continuous assessment as well as adapt and adjust the benefit packages that sensitive towards the changing needs and desires of the workforce.

The Overview of Malaysia HIV Counselling Structure

HIV infection is a chronic disease as there is currently no effective treatment or vaccine which further intensify the psychosocial impacts on HIV patients, their spouse as well as their family. However, HIV transmission is preventable as it is associated with the patients’ behaviour and lifestyle. Therefore, HIV counselling plays a vital role in the prevention and management of HIV transmission. Although studies on the structure of HIV counselling sessions have been done by previous researchers, similar study on the structure of HIV counselling sessions should be done in Malaysia in order to see whether the structure comply with those found in the previous research. Due to the lack of literature on the structure of HIV counselling sessions in the Malaysian context, the need for such research is even more significant in order to contribute to the Malaysian research on HIV. A total of 24 HIV counselling sessions from three government hospitals in Malaysia were recorded, transcribed and analysed. After analysing the data obtained from the audio recorded of HIV counselling sessions, it became apparent that the HIV counselling structure found in this study consisted of different themes which could be distinguished from each other based on the interactional goal each was attempting to achieve in the session and it was evident that the different phases have distinctive interactional structures.

Traditional and Complementary Medicine: Perspective of patients in Sabah, Malaysia

This study was conducted to evaluate the knowledge and perception on the use of (T&CM) and reasons for usage among patients visiting one government hospital in Malaysia. Self-administered questionnaires were distributed to 384 participants. Result showed that the majority of the participants reported using T&CM as an additive to their conventional medicines. Even though, most participants understood of the possible interactions that might occur, when combining T&CM with conventional medicines they remain dedicated to their practice. More study on T&CM should be conducted to ensure the accurate and trusted scientific evidence provided especially in term of safety and efficacy.

Commuting Accidents among Health Care Workers Working in Malaysia Government Hospitals

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HIV Communication Challenges Faced by HIV Specialist Nurses in Malaysia Government Hospitals

HIV counselling is a communication process between a trained nurse and patient to discuss HIV-related problems with a view to assist the patient to manage these problems adequately and appropriately. Lack of communication about HIV-related problems exists and the fact that nurses do not address these problems appropriately could be associated with the sensitive issues involved or the lack of knowledge as how to overcome these problems. Previous studies have identified the challenges health care workers face in disseminating HIV-related information. However, there is an apparent lack of research examining the challenges faced by HIV specialist nurses in Malaysia. Hence, this paper aims to explore the communication challenges faced by HIV specialist nurses in three general hospitals in Malaysia. Five focus group discussions (25 HIV specialist nurses) have been recorded, transcribed and translated. Thirteen communication challenges have been identified and contended for further research exploring communication during HIV counselling by focusing on the impact of these challenges towards HIV specialist nurses’ advice and information giving.

Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study.

Background There is a lack of large comprehensive studies in developing countries on paediatric in-patient prescribing errors in different settings. Objectives To determine the characteristics of in-patient prescribing errors among paediatric patients. Setting General paediatric wards, neonatal intensive care units and paediatric intensive care units in government hospitals in Malaysia. Methods This is a cross-sectional multicentre study involving 17 participating hospitals. Drug charts were reviewed in each ward to identify the prescribing errors. All prescribing errors identified were further assessed for their potential clinical consequences, likely causes and contributing factors. Main outcome measures Incidence, types, potential clinical consequences, causes and contributing factors of the prescribing errors. Results The overall prescribing error rate was 9.2% out of 17,889 prescribed medications. There was no significant difference in the prescribing error rates between different types of hospitals or wards. The use of electronic prescribing had a higher prescribing error rate than manual prescribing (16.9 vs 8.2%, p<0.05). Twenty eight (1.7%) prescribing errors were deemed to have serious potential clinical consequences and 2 (0.1%) were judged to be potentially fatal. Most of the errors were attributed to human factors, i.e. performance or knowledge deficit. The most common contributing factors were due to lack of supervision or of knowledge. Conclusions Although electronic prescribing may potentially improve safety, it may conversely cause prescribing errors due to suboptimal interfaces and cumbersome work processes. Junior doctors need specific training in paediatric prescribing and close supervision to reduce prescribing errors in paediatric in-patients.