Waiting times for elective orthopaedic surgeries in a teaching hospital and their influencing factors

Long waiting time for elective operations is a usable key performance index of ineffi-ciency in services. A cross-sectional study for orthopedic elective surgery waiting times and their influencing factors was done in a teaching hospital, from January 2003 to June 2004; using case-mix patient’s coded records. Main outcomes measured were length of waiting time from first seen at the specialist clinic until surgery (T1) and length of waiting time from the time date of surgery was given until surgery (T2). The median waiting time for T1 was 23 weeks (5.75 months) and 5.86 weeks (1.47 months) for T2. Chi square test was significant for T1 which includes age, comorbidity but only ethnicity was significant for T2. However, multiple logistic regression showed patients paid by third party (OR) of 1.97 (95%CI:1.05-3.72) were significantly likely to wait longer than those who paid out of their own pocket. For T2, women (OR) of 2.29 (95%CI: 1.19-4.42), Indian (OR) of 2.50 (95%CI: 1.16-5.38) and who are self employed (OR) of 4.28 (95%CI: 1.23-14.97) were significantly more likely to have shorter waiting time. Thus predictors for overall waiting time are age, comorbidity, ethnicity, occupa-tion and the method of paying for services rendered by the patients

Economic burden of diabetic care in government health facilities in Selangor

Background : The worldwide prevalence of diabetes is increasing, as is the demand for and cost of medical care. Diabetic Mellitus (DM) prevalence in Malaysia rose from 6.3% of the population in 1986 to 8.3% in 1996 and costs need to be managed more effectively. Objective : To estimate the financial burden of diabetic care, including providers’ and patients’ costs in government facilities in Selangor and to determine factors influencing cost of diabetic care. Methodology : A cross-sectional study was conducted from September to November 2005 among Hospitals with and without Specialist and Health Clinics. Total sample of 361 subjects with type 2 diabetes representing both inpatient and outpatient were chosen randomly. Results were analyzed using SPSS version 13.0. Results : The average cost for a diabetic patients’ admission in a Hospital with Specialist was RM1951 and RM1974 for patient admitted in a Hospital without Specialist and these cost difference was not statistically significant (p>0.05). Providers’ mean cost for outpatient care was RM772.69 and RM761.07 respectively for Hospital with Specialist and Hospital without Specialist per year. As for the health clinics the average providers’ cost for a patient was RM385.92 per year. The cost difference was statistically significant (p0.05). The mean total costs of outpatient care were RM841.46, RM832.80 and RM458.01 per year for Hospital with Specialist, Hospital without Specialist and Health Clinics respectively. Level of care and length of stay were the influencing factors for inpatient provider’s cost. The overall provider’s cost for outpatient diabetic care was influenced by level of care, number of visits and complications. Cost of treating diabetes mellitus year 2004, was estimated at RM18,956,021.51 which was equivalent to 3.3% of total state health expenditure. Conclusion : As much as 60.2 % was spent on management of outpatient diabetic care and 39.8% for management of inpatient diabetic care. Financial burden of diabetic care is predominantly for outpatient care. Therefore, effective and efficient management of outpatient care is needed to improve allocate efficiency, equity, accessibility and appropriateness of the health care system so that the health care services delivered to the nation are of good quality

Prevalence of human papillomavirus genotypes in preinvasive and invasive cervical cancer-A UKM study

A cross sectional study was done to determine the prevalence and distribution of human papillomavirus (HPV) genotypes in pre-invasive (cervical intraepithelial neoplasia, grade 3 or CIN 3) and invasive cervical cancer (ICC), in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 80 paraffin-embedded tumour tissue blocks (20 CIN 3, 60 invasive cancers) between 1999 to 2007 were retrieved from the archives of the Department of Pathology. Patient’s medical records were obtained from the Medical Records Office. Among invasive cancers (n=60), squamous cell carcinoma (SCC) account for 75% and adenocarcinoma 25%. The mean age of cases studied was 52.0 ± 12.2 years and Chinese was the predominant ethnicity (66.3%). Twelve HPV genotypes were identified, namely, HPV 16, 33, 18, 39, 52, 45, 58, 59, 31, 35, 6 and 11. The prevalence of HPV was 92.5% with types 16 being the most common (73.8%), followed by types 33 (30%) and 18 (22.5%). A total of 31 cases (38.8%) showed single HPV genotype, while 43 (53.8%) had multiple HPV (two genotypes or more) genotypes. In ICC, HPV 16, followed by types 33, 18, 52 and 39 were the top five common HPV genotypes detected. High prevalence of HPV and multiple HPV infections were major findings among patients with pre-invasive and invasive cervical cance

Perbandingan klinik swasta di bandar dan luar bandar di Negeri Selangor, 2009

Introduction : Selangor’s private clinic registry system had been introduced in 2006 following gazettment of The Private Healthcare Facilities and Services Act. Through the act, data’s from the private clinics can be obtained and its characteristics can be compared between the urban and rural private clinic. An overview of the services can be known and an appropriate action can be planned. Methodology : A cross-sectional study was done on private clinics registered in state of Selangor. Using databased known as MedPCs (Medical Practice Control System), a purposive sampling was used to select four districts – two urban and two rural. All private clinics in the selected districts were studied and all details shall be collected on line. Result : District of Gombak and Klang were selected as urban and Sabak Bernam and Kuala Selangor represented rural area. Of a total 625 clinics selected, 90.0% (562) from urban and 10.0% (63) rural. Distributions of clinic were in line with the act. The most prominent services were general treatment (89.4%) and ability to serve more than eight hours daily (89.4%). Medical clinic still dominated at 84.0% compared to dentistry at 16.0%. About 70.6% were operated by male doctors. Though clinic services in rural were relatively as good as urban, the different were significantly observed to the ethnicity of the doctor. Indian doctors more in rural (46.03%), whilst in urban, Malay doctors were more dominant (39.50%). Followed closely by seniority, where rural doctors were much senior (51.02 years old), however, most of the doctors in rural private clinics experienced less exposure in government sectors, compared to those in urban areas. Conclusion : There were obvious difference in terms of distribution, where more clinics were located in urban compared to rural, but all were still in line to the act and their services were comparable. Most noticeable differences were ethnicity, seniority and past experience working in the public sector. Indian doctors were dominant in rural and Malay in urban. Although rural doctors were more senior, relatively they were less experienced working in the government sector

Amalan senaman dan faktor-faktor yang mempengaruhinya di kalangan penduduk Kg. Bangi, Daerah Hulu Langat Selangor D.E. Malaysia

Satu kajian keratan rentas telah dijalankan ke atas 285 orang penduduk yang berumur 18 tahun dan ke atas di Kg. Bangi Daerah Hulu langat, Selangor D.E. dari 6-12 Mac 2006. Objektif kajian ini adalah untuk melihat prevalens senaman dan faktor yang mempunyai hubungan dengannya. Kaedah persampelan universal telah digunakan dan pengumpulan data melalui borang soalselidik berpandu. Alatan yang digunakan termasuk penimbang berat Seca dan sfigmomanometer yang telah di kalibrasi, stateskop dan pita pengukur ketinggian. Hasil kajian menunjukkan hanya 13.7% daripada responden yang di kaji di dalam kategori cukup bersenam mengikut definisi kajian. Antara faktor-faktor yang mempunyai hubungan yang signifikan dengan prevalens cukup bersenam adalah jantina (p=0.004), tahap pendidikan (p=0.02) dan status perkahwinan (p<0.0005). Manakala faktor bangsa dan kehadiran penyakit kronik tidak mempunyai hubungan yang signifikan. Bagi jumlah masa bekerja, masa tidur dan masa menonton televisyen didapati tidak mempunyai hubungan dengan jumlah masa senaman. Prevalens kurang bersenam masih tinggi di kalangan penduduk Kg. Bangi. Agensi berkaitan pada semua peringkat perlu mengambil langkah proaktif untuk menanam tabiat suka bersenam di kalangan penduduk dengan mengadakan program dan prasarana yang sesuai dan mencukupi.Pemantauan yang sistematik juga perlu bagi memastikan program dan minat penduduk dapat dikekalkan secara berterusan

Flourescein Angiogram and Funduscopic Features of Radiation Induced Retinopathy: A Descriptive Value of Retinopathy Severity in Patients with Nasopharyngeal Carcinoma

Retinopati akibat dari radiasi (RR) ialah komplikasi yang sering berlaku kepada pesakit Nasopharyngeal Carcinoma (NPC). Kajian ini bertujuan untuk menentukan kaitan RR dengan dos radiasi yang diterima oleh pesakit NPC melalui pemeriksaan mata dan fundus fluorescein angiogram (FFA). Suatu kajian rentas lintang telah dilakukan melibatkan pesakit NPC yang telah menerima rawatan radiasi di Klinik Onkologi, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sebanyak 82 mata dari 42 pesakit telah diperiksa dan prevalence RR didapati sebanyak 35.4%. Keterukan RR berkait rapat dengan dos radiasi kepada retina (Nilai Spearman correlation = 0.48, p<0.001). Antara ciri- ciri RR yang dilihat melalui pemeriksaan FFA ialah salur darah telangiectatic (26.2%) dan capillary non-perfusion (14.3%). Retinal neovascularization dilihat berlaku kepada 10.7% dari mata yang diperiksa. Keterukan penglihatan didapati berkait rapat dengan keterukan RR dengan 26% daripada mata tersebut mempunyai penglihatan 6/18 atau lebih teruk. Lebih dari satu pertiga pesakit mendapat RR, dengan maculopathy radiasi sebagai penyebab yang paling kerap dilihat sebagai penyebab kehilangan penglihatan yang signifikan. FFA ialah alat yang sangat berguna untuk mengesan tanda-tanda awal RR dan maculpathy