Early electroencephalography in patients with Emergency Room diagnoses of suspected new-onset seizures: Diagnostic yield and impact on clinical decision-making

AbstractPurposeTo assess the utility of acute electroencephalography (EEG) performed in the emergency room (ER) and its impact on subsequent management of patients with new-onset seizures. Adults who recover fully in the ER following suspected isolated new-onset seizures are usually discharged to the neurology clinic for further review. An EEG at that stage may be normal. We sought to assess the feasibility and yield of early EEG in the ER setting, its impact on management.MethodsA prospective study from January 2008 to January 2011 of patients diagnosed by ER physicians with uncomplicated suspected first episodes of unprovoked convulsive seizures. All patients underwent routine 30-min EEG in the ER prior to discharge and specialist review was arranged in the epilepsy clinic within 2 weeks of presentation. Management decisions were at the discretion of the treating neurologist. Seizure recurrence was assessed during a follow up period between 9 months and 3 years.Results136 patients were included in the study (92 males). Mean age was 32 years (range 16–73). Forty had abnormal EEGs: 16 focal epileptiform discharges, 12 focal slowing, 10 generalized spike-wave discharges and 2 generalized slowing. Using multivariate analysis, those with abnormal EEG (51% vs 11%, p=0.003) and abnormal MRI (53% vs 28%, p<0.001) were more likely to be commenced on anticonvulsant therapy. Abnormal MRI (p=0.001) was independently associated with a higher risk of recurrence.ConclusionsFollowing an ER diagnosis of new-onset uncomplicated seizure, early EEG had a high diagnostic yield. Abnormal EEG and abnormal MRI significantly contributed to decision-making regarding treatment at specialist review. Abnormal MRI was associated with significantly higher risks of subsequent seizures

Validation of "Care of the Dying Evaluation" in Emergency Medicine (CODE-EM): pilot phase of end-of-life management protocol offered within emergency room (EMPOWER) study.

BackgroundAn increasing number of patients who present to emergency departments are at their end-of-life phase and have significant palliative care needs such as in symptom control for pain and dyspnoea. Evaluating quality of care provided is imperative, yet there is no suitable tool validated in the emergency and Asian settings. We aim to examine the face and construct validity, and reliability of a newly developed questionnaire, Care of the Dying Evaluation - Emergency Medicine, for measuring the quality of end-of-life care in an Asian emergency context.MethodsA mixed methods pilot study was conducted. Participants composed of the next-of-kin to thirty dying patients who presented to the emergency departments of three public hospitals in Singapore. Qualitative evaluation, using cognitive "think-aloud" interviews, and quantitative analysis were employed. Percentage agreement and κ statistic were measured to evaluate temporal stability of the questionnaire. Cronbach's α and item-total correlations were used to assess internal consistency within the constructs. Confirmatory factor analysis was performed for construct validity.ResultsAll participants reported clear understanding of the questionnaire with no ambiguity; a minority felt the questions caused emotional distress (7/30, 23.3%). The questions showed moderate to good test-retest reliability. Internal consistencies within the constructs were good for "ENVIRONMENT" and "CARE", and moderate for "COMMUNICATION". Factor loadings range from 0.40 to 0.99.ConclusionsThe Care of the Dying Evaluation - Emergency Medicine questionnaire may be valid and reliable for use in an Asian emergency setting. Our prospective multicentre study using this evaluation tool may provide more insight on the quality of care rendered to dying patients and identify areas for improvement.Trial registrationClinicalTrials.gov (NCT03906747)

Not all unexplained hypoxia is pulmonary embolism

10.11622/smedj.2015031Singapore Medical Journal562e32-e3

RAGS15-000-0123/The implication of goods and seryices tax operators in Malaysia

Malaysia is reputed to be a leader in the Takaful industry within the ASEAN region commanding a market share that exceeds 70 per cent of gross Takaful contribution. The industry however is not exempted from the recent implementation of the Malaysian Goods and Services Tax (GST) in April 2015. This research project seeks to examine the specific Shari‘ah issues and challenges that may be triggered off by GST application on its operations. Other that, this research investigates the implication of GST towards the performance of Takaful operator in Malaysia even though the recent government have changed the rate of GST from 6% to 0%. Therefore, secondary data that is reliable in this research would be from 2013-2017. Accordingly, to achieve the first objective, an inductive analysis is undertaken on the relevant sources that justify GST implementation in Takaful, mainly guidelines provided by Customs Department, and also arguments from scholars on the likely contravention of Shari‘ah principles with the application of GST. Meanwhile, mixed methodology approach is adopted to observe the performance of Takaful operators during the five years period of GST which based on secondary data as well as interview sessions with Takaful representatives. After examining those supply services which are subjected to GST, the researchers conclude that the Shari‘ah issues that emerged is basically related to the contract of Takaful which is donation in nature which should not be treated similar with the conventional counterparts. In addition, Takaful riders like critical illness, medical and personal accident benefits which considered as basic needs (Dharuriyyat), shall be given tax exemption. In addition, based on Data Envelopment Analyis (DEA), The study has found that the efficiency for Takaful industry negatively impacted by the GST implementation. However, the analysis is also shown the reduction in the year 2014 compare to 2013 in the absence of GST. But compare to 2015 and 2016, the percentage of difference is in 2014 from 2013 is significantly less. This results also parallel with the results from interview sessions conducted with Takaful representatives where they reported that there are many other factors that have influenced the performance of the operators rather than the GST per say. Therefore, GST have not significantly affect the performance of the operators and the industry in general. Overall, in case of the government continue with the 6% GST rate, it is suggested to remain GST exemption on wakalah fee, fund management fee and family Takaful product. GST on Takaful is proposed to be restricted on fee & charges (ujrah based) with tax exemption on all type Tabarru’ and of all type of Takaful benefits that cater for the public needs. Hence, given that the new government have ruled with 0% GST, it is therefore grateful to the Takaful industry and the operator where their burden have been reduced. It is hope that this positive change will boost the performance of Takaful industry in the future

An Indispensable Procedure to Complete Passive Leg Raising Reply

10.1016/j.annemergmed.2016.04.008ANNALS OF EMERGENCY MEDICINE683395-39

Death among elderly patients in the emergency department: a needs assessment for end-of-life care

10.11622/smedj.2016179SINGAPORE MEDICAL JOURNAL583129-13

An analysis of the role and competency of the Shari'ah Committees (SCs) of Islamic Banks and Financial Service Providers

IFSB’s Guiding Principles on Shari'ah Governance Systems for Institutions Offering Islamic Financial Services defines “Shari'ah governance system” as the set of institutional and organisational arrangements through which an institution offering Islamic financial services oversees Shari'ah compliance, i.e., that Islamic banking products and operations are in accord with Shari'ah principles. This requires the establishment of a Shari'ah advisory board. The Shari'ah governance of Islamic financial institutions (IFIs) in Malaysia consists of two components: the Shari'ah apex body, which is the Shari'ah Advisory Council (SAC) established by the Commission, and the Shari'ah advisors appointed by the respective institutions (Shari'ah Committees). Their roles are directing, reviewing, supervising and approving or rejecting the activities of IFIs in order to ensure compliance with Shari'ah rules and principles. The extent to which Islamic banks comply with Shari'ah principles is, to a great extent, determined by the role of such boards. Consequently, this body needs sufficient authority to enable its members to perform their functions effectively. However, many issues have arisen about the role and competency of Shari'ah advisors. This research aims to examine the current practice of Shari'ah advisory in Malaysia from the perspectives of advisors, bankers and regulators. The research focuses on the roles and functions practically played by the Shari'ah advisors and the IFIs’ expectations of them. Problems faced by the Shari'ah advisors, bankers and regulators need to be specifically identified so that measures to bridge the gaps between them may be proposed. This will ensure a harmonious relationship between all stakeholders as well as ensuring that the dayto-day running of IFIs will be compliant with Islamic law

Asynchronous platform for a resident research showcase

10.1111/medu.14333MEDICAL EDUCATION54111068-106

الحكومة الشرعية في المؤسسات المصرفية الإسلامية في مختلف الولايات القضائية: دراسة تحليلية مقارنة

الحكومة الشرعية هي بنية مؤسسية فريدة من نوعها في الأعمال المصرفية والتمويل الإسلامي. وكانت وظيفتها هي ضمان التزام المصرفية الإسلامية وعملياتها التمويلية لأحكم الشريعة الإسلامية. وقد اتخذت الحوكمة الشرعية هيكلها الرسمية المختلفة في بلدان مختلفة باختلاف الاطار القانوني الذي ينظم مختلف الأعمال المصرفية والتمويل الإسلامي في البلدان المعنية. تبحث هده الوراقة ممارسة المصارف الإسلامية للحكومة الشرعية في مختلف الولايات القضائية. وكان الغرض من هذه الراسة هو تقديم فهم أفضل لبعض الممارسات المختلفة للحوكمة الشريعة، وتسليط الضوء على القضايا وتقديم المعلومات ذات الصلة من أجل توجيه التنمية المستقبلية لنظام الحوكمة الشريعة في الصناعة المالية الإسلامية. وتناقش الورقة حالة ممارسات الحوكمة الشرعية في تسع دول وهي ماليزيا وإندونيسيا والمملكة المتحدة وباكستان والكويت والإمارات العربية المتحدة والبحرين وبروني وسنغافورة، والتي هي من أهم الاعبين في المالية الإسلامية. تقوم الدراسة بتحليل القوانين الدول المعنية وكذلك الأنظمة التي تحكم الحوكمة الشريعة لهذه الدول. كما اعتمدت الورقة على الراسات المكتبية والمعلومات والبيانات المستقاة من مصادرها الأولية ومقابلات مع أفراد معينين من مختلف الولايات القضائية This article discusses the Shariah Governance Framework for Islamic banking in specific jurisdictions which are Malaysia, Indonesia, Brunei, Singapore, Pakistan, United Arab Emirates, United Kingdom, Bahrain and Kuwait. It critically examines the practice of supervisory and advisory at both level, national and institution level. It also discusses the relationship between the two levels of supervisions and the interaction between them