Hospital In Malaysia Research Articles

Validity and measurement equivalence of EQ-5D-5L questionnaire among heart failure patients in Malaysia: a cohort study

ABSTRACT Aim: This study aimed to examine the validity of EQ-5D-5L among HFrEF patients in Malaysia, and to explore the measurement equivalence of three main language versions. Methods: We surveyed HFrEF patients from two hospitals in Malaysia, using Malay, English or Chinese versions of EQ-5D-5L. EQ-5D-5L dimensional scores were converted to utility scores using the Malaysian value set. A confirmatory factor analysis longitudinal model was constructed. The utility and visual analog scale (VAS) scores were evaluated for validity (convergent, known-group, responsiveness), and measurement equivalence of the three language versions. Results: 200 HFrEF patients (mean age = 61 years), predominantly male (74%) of Malay ethnicity (55%), completed the admission and discharge EQ-5D-5L questionnaire in Malay (49%), English (26%) or Chinese (25%) languages. 173 patients (86.5%) were followed up at 1-month post-discharge (1MPD). The standardized factor loadings and average variance extracted were ≥ 0.5 while composite reliability was ≥ 0.7, suggesting convergent validity. Patients with older age and higher New York Heart Association (NYHA) class reported significantly lower utility and VAS scores. The change in utility and VAS scores between admission and discharge was large, while the change between discharge and 1MPD was minimal. The minimal clinically important difference for utility and VAS scores was ±0.19 and ±11.01, respectively. Malay and English questionnaire were equivalent while the equivalence of Malay and Chinese questionnaire was inconclusive. Limitation: This study only sampled HFrEF patients from two teaching hospitals, thus limiting the generalizability of results to the entire heart failure population. Conclusion: EQ-5D-5L is a valid questionnaire to measure health-related quality of life and estimate utility values among HFrEF patients in Malaysia. The Malay and English versions of EQ-5D-5L appear equivalent for clinical and economic assessments.

Critical Care Nurses’ Perception of Medication Administration Errors in Kelantan, Malaysia: A Cross-Sectional Study

Background. The study investigates critical care nurses’ perceptions of medication administration errors (MAEs) in a tertiary hospital in Kelantan, Malaysia, within the unique sociocultural context of East-Coast Malaysia. The research aims to understand the causes and underreporting of MAEs and assess the proportion of reported incidents according to MAE types. Methods. A cross-sectional study involving 424 critical care nurses from Hospital Raja Perempuan Zainab II (HRPZII), Hospital Sultan Ismail Petra (HSIP), and Hospital Tanah Merah (HTM) was conducted. Nurses in administrative roles or unavailable during the survey period were excluded. The study utilized a validated Medication Administration Errors Survey questionnaire to gauge nurses’ perceptions on the causes of MAEs, reasons for underreporting, and the percentage of reported incidents based on MAE types. Results. Results indicate that illegible medication orders from doctors were identified as the primary cause of MAEs, while a lack of 24-hour pharmacist availability received the lowest score. The most common reason for not reporting MAEs was identified as the nursing administration’s focus on individuals rather than systemic issues when errors occur. The majority of MAEs were non-intravenous, with incorrect timing of administration being the leading cause. Conclusion. The study sheds light on critical care nurses’ perspectives on MAEs in a Malaysian hospital setting, highlighting key factors contributing to these errors and barriers to their reporting. Understanding these perceptions is crucial for developing strategies to mitigate MAEs and enhance patient safety in critical care environments.

HIV–A prognostic factor of tuberculous meningitis: A retrospective cohort study among adults in peninsular Malaysia

<b>Background:</b> Tuberculous meningitis is a major public health issue, despite showing low incidence, tuberculous meningitis causes substantial mortality. For better clinical management, identification of prognostic factors is crucial to reduce health risk of Malaysian society. Therefore, the aim of this study was to determine the prognostic factors of adult tuberculous meningitis in peninsular Malaysia.<br /> <b>Materials & methods:</b> Initially, a retrospective cohort study and one-year of follow-up period was carried out. In addition, a total of 217 adult tuberculous meningitis patients treated or had follow-up in four tertiary hospitals in peninsular Malaysia were recruited. Cox proportional hazards regression was employed to perform multivariable analysis.<br /> <b>Results:</b> The overall survival probability of adult tuberculous meningitis was 36.8% with median survival time 244 days. Significant prognostic factors were Glasgow coma scale score (aHR=0.71, 95% CI=0.65, 0.76; p<0.001), HIV status (aHR=1.94, 95% confidence interval [CI]=1.19, 3.15; p=0.008), headache (aHR=0.48, 95% CI=0.31, 0.76; p=0.002) and meningeal enhancement (aHR=0.47, 95% CI=0.30, 0.74; p=0.001), nausea (aHR=2.21, 95% CI=1.33, 3.66; p=0.002), and vomit (aHR=0.58, 95% CI=0.36, 0.93; p=0.023).<br /> <b>Conclusions:</b> Evidently, the survival of among adults with tuberculous meningitis was low. Since HIV positive has a significant influence in mortality; early screening, diagnosis, and prompt treatment in this subgroup of patients play a key role in survival.

Exposure to potentially harmful excipients in medications among neonates at a state hospital in Malaysia

Objectives This study aimed to determine the incidence, types and predictors of Potentially Harmful Excipients (PHE) exposure among hospitalized neonates. Methods A prospective observational study was conducted from March to April 2022 in neonatal wards at a state hospital in Malaysia. The PHEs of interest were aspartame, benzalkonium chloride, benzyl alcohol, benzoic acid or benzoates, ethanol, parabens, polysorbate 80, propylene glycol, saccharin sodium, sorbitol and sulfites. Product information leaflets (PILs) and summaries of product characteristics (SPCs) were referred to obtain information on active pharmaceutical ingredient, strength, trade name as well as type and amount of the excipients. Results A total of 108 neonates were recruited and 97.2% of them were exposed to at least one PHE. Parabens (47.2%) and sulfites (27.5%) were the two most commonly administered PHEs. Benzyl alcohol is contraindicated in neonates but was administered to 8% of neonates in this study. The median daily dose of ethanol (24.11 mg/kg/day, IQR 19.73, 28.49) exceeded the acceptable daily intake (ADI) by four times. However, the dose was not available for all PHEs as this information is not always available in the PIL or SPC. Administration of cardiovascular drugs was associated with a higher risk of exposure to any PHE (OR 6.38, CI 2.75, 14.79, p-value < 0.001). Conclusion The exposure of PHE among neonates in this study is high with certain PHEs exceeding the ADI. It highlights the need for certain strategies to be implemented to reduce such exposure in neonates.

“I suppose in our culture, old means no sex”: PLWH and healthcare provider views on factors influencing late HIV testing and diagnosis among older adults in Malaysia

ABSTRACT The proportion of new HIV diagnoses among older adults aged ≥50 years continues to rise. Older adults are at higher risk of late diagnosis which is associated with higher treatment complexity and poorer health outcomes. Few studies in the Asia-Pacific region have explored factors contributing to late presentation and diagnosis in this population. Thus, our study aimed to explore factors influencing late HIV diagnosis among older adults ≥50 years in Malaysia. We conducted in-depth interviews with 16 older adults newly diagnosed with HIV (OPLWH) and focus group discussions with seven healthcare providers (HCPs) from different specialties in an academic tertiary hospital in Malaysia. All sessions were audio-recorded, transcribed verbatim and analysed thematically. Three main themes related to late diagnosis among OPLWH emerged: (1) challenge in recognizing HIV symptoms among older persons, (2) older persons and HCPs having low index of suspicion of HIV and (3) poor acceptance of HIV testing among older persons due to perceived personal and social identities. HCPs often missed HIV symptoms and these collectively culminated in OPLWH experiencing complex diagnostic journeys resulting in late HIV diagnosis. To reduce delays in HIV diagnosis, strategies are needed to improve HIV knowledge and risk perception among both older adults and HCPs.

Gluten sensitivity based on HLA genotyping in patients with epilepsy in a tertiary hospital in Malaysia

AbstractIntroductionGluten sensitivity (GS) is present in approximately 1% of the Malaysian population (Yap et al., PLoS One, 10, 2015, e0121908). GS is associated with several neurological conditions including epilepsy. Individuals with GS often exhibit a genetic predisposition associated with human leukocyte antigens (HLA) (Cecilio &amp; Bonatto, Arq Bras Cir Dig, 28, 2015, 183). The purpose of this study was to investigate the prevalence of GS based on HLA genotyping in patients with epilepsy (PWE).MethodIn total, 50 PWE and 50 controls were recruited. DNA was extracted from the venous blood samples and genotyped for HLA‐DQ2.2, DQ2.5, DQ7 and DQ 8. In this study, GS was diagnosed if any subject showed positive for one or more of the HLA‐DQ alleles. The type of epilepsy and number of antiseizure medication (ASM) used were recorded.ResultsOnly 2 alleles (HLA‐DQ 2.2 &amp; HLA‐DQ8) were detected among 46 out of 100 subjects. 18 PWE and 19 controls were positive for HLA‐DQ8 (p = 0.836). 9 of the PWE, but no controls were positive for HLA‐DQ 2.2 (p = 0.003). 8 of these 9 PWE who were positive for HLA‐DQ 2.2 were also positive for HLA‐DQ8 (double positive), and these patients required multiple ASM for seizure control (p = 0.006).ConclusionHLA‐DQ2.2 was seen highly prevalent in PWE. The double positives required more than one ASM for seizure control postulating malabsorption of ASM in these individuals. These findings suggest that HLA‐DQ genotyping may be a valuable additional test in PWE especially in those needing more than one ASM. Prescribing gluten‐free diet (GFD) to PWE with GS may potentially be an additional measure to achieve seizure control.

A Conceptual Framework on Factors Influencing Nurses’ Job Performance

The nurses' job performance can be regarded as a reflection of healthcare organizations, given that they comprise the largest group of human resource professionals who are responsible for providing high-quality care to patients. However, previous studies have emphasized that nurses in Malaysia are underperformed because of shortages in the workforce and excessive workload. Hence, understanding factors influencing the job performance of nurses will empower decision-makers to develop effective strategies aimed at enhancing nurses' performance. In Malaysia, only a few research have been performed on job performance, especially among nurses. Furthermore, limited research has delved into the specific factors influencing nurses’ job performance in Malaysia’s public hospital system. This study contributes to the existing knowledge by investigating the impact of spirituality at work and HRM practices on the nurses’ job performance in Malaysian public hospitals. This study employs a quantitative survey method using self-administered questionnaires, and the data collected will be analyzed using SPSS software Version 26. A total of 375 nurses from a population of 12, 514 nurses who worked at public hospitals in Malaysia will be selected as a sample of the study. This study offers potential benefits to authorities in Malaysian healthcare organizations by providing valuable insights for the development of compelling effective spirituality at work values and human resource management strategies aimed at enhancing the job performance of nurses.

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.

Infective Versus Non-Infective Respiratory Illness Admissions: Comparative cost analysis in a tertiary hospital in Malaysia

Background: Severe Acute Respiratory Infection (SARI) that is mainly caused by the Influenza virus, poses a significant public health threat, demanding timely detection and preventive measures. This study assesses the financial implications of managing two distinct respiratory conditions: SARI and Acute Exacerbation of Bronchial Asthma (AEBA). Method: Data were collected for 100 patients, with 50 cases of SARI and 50 cases of AEBA, admitted to Hospital Canselor Tuanku Muhriz (HCTM) from July to December 2022. Cost analysis was conducted from a provider perspective, considering factors such as building, asset, emolument, overhead, utility, medication, consumables, and laboratory and imaging expenses. Results: The study revealed that the average total cost of treating SARI patients was RM 1,587.11 ($US334.80), significantly higher (30.7%) than AEBA patients at RM 1,214.41 ($US256.18).This was mainly due to the acute and severe nature of SARI, requiring more intensive medical interventions, potentially leading to complications and greater strain on healthcare resources. The study highlighted the economic challenges posed by SARI, provided valuable insights for resource allocation and public health planning. The study's limitations include retrospective data collection and potential underestimation of actual costs due to top-down costing methodology. Conclusion: SARI, especially in the elderly population, leads to substantial healthcare costs and economic impact. Effective preventive measures, such as vaccination, are crucial in reducing the burden of influenza-related illnesses. Health financing plays a vital role in addressing communicable diseases and ensuring the well-being of the population.

Illness Perceptions in Patients with Coronary Artery Disease in a Private Hospital in Malaysia

Illness Perceptions in Patients with Coronary Artery Disease in a Private Hospital in Malaysia

Electric massage chairs reduce labor pain in nulliparous patients: a randomized crossover trial

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the massage chair with mechanical massage followed by 30 minutes on the massage chair without mechanical massage, or the other way around in massage sequence. The primary outcome was change in pain score comparing pain with and without mechanical massage as a paired comparison for the entire trial participants. Secondary outcomes were across arms analyses of maternal and neonatal outcomes. The paired t-test, t test, Mann- Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.RESULTS: 208 women were randomized; 104 to each intervention. Data was available from 204 participants (103 randomized to massage first and 101 to no massage first). The primary outcome of change in labor pain score (0-10 Numerical Rating Scale, NRS) after massage and no massage (all participants included after crossover, paired t-test analysis) was mean±standard deviation 4.51±2.3 vs 5.38±2.1 mean difference - 0.87 (95% CI -1.14 to -0.59), p<0.001, a significant reduction in pain score after electric chair mechanical massage compared to no massage. On the across randomized arms secondary analyses, labor pain score after their first massage chair session was 4.35±2.52 (randomized to massage first, received massage as initial intervention) vs 5.66±1.73 p<0.001 (randomized to no massage first, received no massage as initial intervention) mean difference -1.31 (95% CI -1.91 to -0.748), a significant reduction after mechanical massage. Other distal maternal outcomes (mode of delivery, labor analgesia, duration of labor and maternal agreement that mechanical massage is effective for labor pain) and neonatal outcomes (Apgar score at 1 and 5 minutes, cord artery blood pH and base excess, and neonatal admission) were not different across randomized arms.CONCLUSION: Mechanical massage using an electric massage chair significantly reduces labor pain, offering a potential non-pharmacologic pain management option during labor.

REKOVER study protocol: a pRospective patient treatment rEgistry of tramadol and dexKetoprofen trometamol oral fixed-dose combination (SKUDEXA) in mOderate to seVere acutE pain in Real-world setting in Asia

IntroductionSatisfactory management of acute pain remains a major medical challenge despite the availability of multiple therapeutic options including the fixed-dose combination (FDC) drugs. Tramadol and dexketoprofen trometamol (TRAM/DKP) 75/25 mg...

Covid-19 Impact to Retail, Hospitality, and Office Space in Malaysia

Abstract The COVID-19 pandemic has disrupted economies and industries worldwide, including the real estate sector. This study aims to assess the effects of the pandemic on commercial real estate prices in the Malaysian market. By examining variations in property types and considering key factors influencing pricing, the research contributes to a better understanding of the pandemic’s impact on the real estate market. To analyze the effects of the COVID-19 pandemic on commercial real estate prices, a mixed-method approach was employed. The study combines data from direct real estate indices, which provide insights into property prices based on transaction data, and listed real estate, which includes publicly traded real estate investment trusts (REITs). By utilizing both sources, a comprehensive analysis of the market is achieved. The sample for this study consists of commercial real estate properties in the Malaysian market. It includes properties from various sectors, such as retail, hospitality, and office buildings. The sample is representative of the overall market and captures the different property types affected by the pandemic. The analysis begins by comparing direct real estate indices to highlight the limitations and potential biases associated with using these indices. It then examines the variations in commercial real estate prices during the COVID-19 outbreak, focusing on the different property types. Statistical techniques, such as regression analysis and trend analysis, are employed to identify patterns and quantify the impact on commercial real estate prices. The study’s main findings reveal that the retail and hospitality sectors experienced the most significant impact on commercial real estate prices during the COVID-19 pandemic. These sectors witnessed a substantial decline in property values due to restrictions, lockdown measures, and reduced consumer demand. Office buildings, although moderately affected, also experienced some decline in prices. This research contributes to the existing literature on the effects of the COVID-19 pandemic on commercial real estate prices, specifically in the Malaysian market. By combining data from direct and listed real estate sources, the study provides a comprehensive understanding of the variations in property prices across different sectors. The findings offer valuable insights for real estate investors, policymakers, and industry professionals in adapting to the changing market conditions and making informed decisions regarding commercial real estate investments. In conclusion, this article sheds light on the effects of the COVID-19 pandemic on commercial real estate prices in the Malaysian market. The research methodology, which combines data from direct and listed real estate, allows for a comprehensive analysis of property variations among different sectors. The findings emphasize the significant impact on the retail and hospitality sectors, while showing office buildings to have been moderately affected. It also provides important insights for stakeholders in the real estate industry, enabling them to make informed decisions and develop appropriate strategies.

Infection prevention and control compliance among nurses and nursing students during COVID-19 in Malaysia

The Malaysian COVID-19 hospital admission rate and the intensive care wards usage are now declining as the health service system enters a stage of recovery in the endemic phase. This study aimed to explore the barriers to and facilitators of infection prevention and control (IPC) compliance among staff nurses and nursing students and to observe their IPC compliance when attending to the patients in the respective wards. Qualitative study using in-depth interviews was conducted with staff nurses and the nursing students as primary data collection methods and supported with direct observation in the wards. A total of 21 staff nurses and 14 undergraduate nursing students from multiple wards were purposively sampled from April to December 2022. Data were analyzed using thematic analysis in Nvivo software. Four key themes were emerged in this study such as the partcipants i) Narrating IPC compliance; ii) IPC compliance adherence; iii) Perceived barriers for noncompliance to IPC; iv) Empowering staff nurses and nursing students on IPC compliance. The study findings served as key evidence for the hospital top management and the nursing faculty in planning the strategies to improve the IPC training and monitoring by empowering staff nurses and nursing students at their teaching hospitals.

Mediating Role of Social Media in Medical Tourism Visit Decision: A Behavioural Perspective

Social media (SM) has become the main communication medium for both personal and professional communication on a global scale. Despite its many benefits, it is challenging to persuade consumers to accept and use SM as a platform for exchanging health-related information. In contrast to other businesses where individuals utilise social media to freely share their real-life experiences, marketing medical tourism through interactive communication creates several hurdles owing to sensitive matters such as patient health and underlying risk. Healthcare providers' advertising activities and medical tourists' choices to visit are becoming increasingly reliant on social media platforms. Potential medical tourists should use this technology to benefit from SM and learn more about health care. The goal of this research was to see if SM impacts a person's decision to travel to a medical tourism destination. The researcher’s major focus was on social media platforms as a mediator element for medical tourists, as well as their effect on decision-making. To better understand how new technologies are adopted and utilised, the Unified Theory of Acceptance and Use of Technology (UTAUT) and Theory of Planned Behaviour (TPB) were used to research new technology adoption and user behaviour, respectively. These will serve as the study's fundamental hypotheses. The Statistical Package for Social Sciences (SPSS) and Structural Equation Modelling (SEM) - Partial Least Squares (PLS) will be utilised for data analysis. This study's participants will be medical tourists seeking treatment in Malaysian private hospitals.

Prevalence of Preterm Birth and Perinatal Outcomes in a Tertiary Hospital in Malaysia.

Background Preterm 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. Objective To assess the prevalence of PTB and the perinatal outcome among women delivered in a tertiary university hospital in Malaysia. Methods This was a cross-sectional study evaluating all singleton live births weighing>500g and delivered at>22+1weeks 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). Results A 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+1and 33+6have a higher risk of neonatal mortality compared to late preterm babies. Conclusions The 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.

Cost-benefit Analysis of Adopting Blockchain Technology in the Radiology Unit of a District Hospital

Background: Blockchain technology has better security and immutable features, which are beneficial for healthcare data management. Decentralisation data management allows better sharing of medical images between units and departments. Objectives: The objectives of this study were to determine the cost of adopting the blockchain-based system for medical images and the cost-benefit analysis for five years of adoption of this technology at a district hospital in Malaysia. Methodology: Data regarding the yearly costs and workload for 2016 until 2018 were collected from a district hospital in Malaysia. The cost of blockchain implementation was obtained from a company that developed this technology. The cost-benefit analysis was done using the capital budgeting method for five years of this technology adoption. Sensitivity analysis was done to assess uncertainty conditions during this adoption. Results: The total yearly cost of Radiology Unit for 2018 was MYR490,168.96. The cost for adopting blockchain technology was MYR80,000 for the software, MYR115,000 for upgrading the assets and yearly maintenance cost was MYR16,000. The total present value of net benefits for five years of technology adoption was MYR865,295.01. Sensitivity analysis shows that consumables cost-saving is the most sensitive variable. Most pessimistic situation analyses showed positive net benefits. Conclusion: The adoption of blockchain technology in managing medical images offers numerous benefits to public hospitals in Malaysia. Investment in this technology can provide a good return to the organisation.

Age at autism spectrum disorder diagnosis and its association with child and family characteristics in a tertiary care hospital in Malaysia.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Despite the absence of a cure, early diagnosis and intensive early intervention can improve the outcomes. However, little is known about the median age at ASD diagnosis in Malaysia or the child/family characteristics associated with early diagnosis. Therefore, this study aimed to determine the median age at ASD diagnosis among Malaysian children presenting to the country's largest public tertiary neurodevelopmental center and to investigate the possible demographic, child, and family characteristics associated with an early age at diagnosis. Data were collected between February 2017 and February 2019 from a database maintained by the child development unit of the country's largest publicly funded tertiary hospital, containing data from an ethnically diverse population. Among Malaysian children attending the clinic, the median age at ASD diagnosis was 48 months. Early autism diagnosis (<36 months of age) was associated with increased severity of social communication and interaction impairments, coexisting intellectual impairment, children from high socioeconomic status families, and children who receive joint care from their families and a maid or babysitter. The study findings highlight the socioeconomic inequalities in the country, a lack of parental awareness of early ASD signs, and the presence of cultural influences on the age at diagnosis of ASD.

Barriers to Education for Children With Neurodisabilities in a Developing Country.

Despite having equal rights to education, children with neurodisability (CWND) continue to face a myriad of barriers to education. This cross-sectional survey aimed to investigate the barriers to education among CWND who attended follow-up at a Malaysian tertiary hospital. Sixty-two caregivers of CWND completed a questionnaire which included the 'Washington Group/United Nations Children's Fund (UNICEF) Child Functioning Module', type of schooling and open-ended questions for barriers to education. The out-of-school rate was 16/62 (26%). The level of schooling (i.e. not in school, special education or mainstream class) was strongly associated with difficulties in mobility, self-care, communication, controlling behaviour and getting along with other children. Five themes identified by caregivers as barriers to education were 'school infrastructure', 'inclusive opportunity, staffing and teacher's training', 'social environment', 'child's intrinsic factor'and 'practical limitations'. Practical solutions to overcome the significant barriers to education are required to address the unmet educational needs of CWND.

Hospital brand image and trust leading towards patient satisfaction: medical tourists’ behavioural intention in Malaysia

In Malaysia, hospital branding is critical to recruiting medical tourists. Reputation, service quality, and word-of-mouth influence hospital branding. Thus, hospitals and the healthcare tourism sector must understand these elements to gain a competitive edge in the global market. This study investigated the effect of hospital advertising factors on healthcare tourists’ behavioural intentions (BI) in Malaysia, with emphasis on clarifying the nature of hospital brand image and hospital brand trust. Additionally, the study assessed how perceived standards and satisfaction stimulate favourable BI among healthcare tourists. This study used the quantitative research-based deductive approach, where hospitals in Malaysia were the target sector. The results demonstrated that accessibility, cost, and a good web presence influenced hospital marketing for medical tourism. Furthermore, the characteristics of safety and security and effective advertising enhance trust. Moreover, patient satisfaction is critical to reduce the divide between service standards and BI, which emphasises the necessity of prioritising patients in medical facilities. Nevertheless, the findings were time-sensitive and not adjusted for healthcare tourism sector alterations or customer habit variations over time.