Doing Business in Malaysia

[Excerpt] Malaysia is a federation of thirteen states and two federal territories in West (Peninsular) Malaysia and East Malaysia with a population of over 20 million. It is rich in natural resources (including oil and natural gas) and is a major producer of palm oil, natural rubber, tin and tropical hardwoods. The Government encourages industry and foreign investment, particularly in high technology and resource-based export-oriented industries. Malaysia has attracted much interest from multi-national companies due to its economic growth and future potential

Prevalence of drugged drivers among non-fatal driver casualties presenting to a trauma centre in Hong Kong

OBJECTIVE: To investigate the prevalence and characteristics of abusive drug exposure among non-fatal motor vehicle driver casualties presenting to a designated trauma centre in Hong Kong. DESIGN: Cross-sectional study. SETTING: Designated trauma centre/regional accident and emergency department in Hong Kong. SUBJECTS: Non-fatal motor vehicle driver casualties who presented to the trauma centre from 1 January 2007 to 31 December 2007. MAIN OUTCOME MEASURES: Screening of abusive drug exposure using commercial bedside urine immunoassay kits. RESULTS: Drug screening was performed in 395 injured drivers, 10% of whom tested positive for the drugs of interest. Ketamine was the most commonly detected abusive substance (found in 45% of the subjects). A significantly higher proportion of young drivers (aged <25 years) screened positive (odds ratio=2.3; 95% confidence interval, 1.0-5.2; P=0.04), with the rate being 21%. The presence of these drugs in urine was related to the time of occurrence of the crash; those occurring between midnight and dawn revealed a trend towards a higher proportion of casualties testing drug-positive (odds ratio=2.2; 95% confidence interval, 0.9-5.3; P=0.07). There were no significant differences in the frequency of persons testing positive for the screened drugs with respect to gender, class of motor vehicle driven, or the day of the week on which the crash occurred. CONCLUSIONS: The prevalence of drugged driving among non-fatal casualties in our series of Hong Kong drivers was 10%. The frequency of such drivers testing positive for drugs was significantly higher in persons aged less than 25 years. These findings indicate a need to amend existing laws and implement on-site drug screening for suspected drugged drivers.published_or_final_versio

Suppression of the postoperative neutrophil leucocytosis following neoadjuvant chemoradiotherapy for rectal cancer and implications for surgical morbidity

Objective: The extent to which neoadjuvant chemoradio- therapy for rectal cancer influences postoperative morbid- ity is controversial. This study investigated whether this treatment suppresses the normal perioperative inflamma- tory response and explored the clinical implications. Method: Prospective databases were queried to identify 37 consecutive study patients undergoing definitive surgery following 5-FU ⁄ capecitabine-based chemoradio- therapy and 35 consecutive untreated control patients operated upon for rectal or rectosigmoid cancer. Preop- erative (< 10 days) and postoperative (< 24 h) neutrophil counts, along with morbidity data, were confirmed retrospectively. Univariate and multivariate analyses assessed the apparent effect of chemoradiotherapy on change in neutrophil count. The latter’s association with postoperative morbidity was then examined. Results: Sufficient data were available for 34 study and 27 control patients. Repeated-measures ANCOVA revealed significant differences between their periopera- tive neutrophil counts (P = 0.02). Of the other charac- teristics which differed between the groups, only age and tumour location were prognostically significant regarding perioperative change in neutrophil count. Accounting for relevant covariates, chemoradiotherapy was significantly associated with a suppressed perioper- ative neutrophil leucocytosis. Local postoperative com- plications affected 25 of 61 patients, who had lower perioperative neutrophil increases than their counter- parts (P = 0.016). Conclusion: Chemoradiotherapy appears to suppress the perioperative inflammatory response, thereby increasing susceptibility to local postoperative complications

Homeward bound or bound for a home? Assessing the capacity of dementia patients to make decisions about hospital discharge: Comparing practice with legal standards

Background This article stems from a larger project which considers ways of improving assessments of capacity and judgements about best interests in connection with people with dementia admitted to acute hospitals with respect to decisions about place of residence. Aims Our aim is to comment on how assessments of residence capacity are actually performed on general hospital wards compared with legal standards for the assessment of capacity set out in the Mental Capacity Act, 2005 (MCA). Method Our findings are grounded in ethnographic ward-based observations and in-depth interviews conducted in three hospital wards, in two hospitals (acute and rehabilitation), within two NHS healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Twenty-nine patient cases were recruited to the study. We also draw from broader conceptions of capacity found in domestic and international legal, medical, ethical and social science literature. Results Our findings suggest that whilst professionals profess to be familiar with broad legal standards governing the assessment of capacity under the MCA, these standards are not routinely applied in practice in general hospital settings when assessing capacity to decide place of residence on discharge from hospital. We discuss whether the criteria set out in the MCA and the guidance in its Code of Practice are sufficient when assessing residence capacity, given the particular ambiguities and complexities of this capacity. Conclusions We conclude by suggesting that more specific legal standards are required when assessing capacity in this particular context

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems

Patients’ preferences for nutrition-related health outcomes in liver disease : a preliminary study using an electronic questionnaire

Background: Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients’ needs are associated with better health outcomes but no studies investigating patients’ preferences for nutrition-related outcomes in liver disease have been published. The aim of this study was to identify nutrition-related health outcomes that are important to patients with liver disease. Methodology: An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results: Fifty-one patients participated (22 men / 29 women). Responses indicated a wide range of preferred nutrition-related outcomes with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, and on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions: The study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.Peer reviewedFinal Accepted Versio

Patient Safety Training in Pediatric Emergency Medicine: A National Survey of Program Directors

Objectives The Accreditation Council for Graduate Medical Education requires training in patient safety and medical errors but does not provide specification for content or methods. Pediatric emergency medicine ( EM ) fellowship directors were surveyed to characterize current training of pediatric EM fellows in patient safety and to determine the need for additional training. Methods From June 2013 to August 2013, pediatric EM fellowship directors were surveyed via e‐mail. Results Of the 71 eligible survey respondents, 57 (80.3%) completed surveys. A formal curriculum was present in 24.6% of programs, with a median of 6 hours (range = 1 to 18 hours) dedicated to the curriculum. One program evaluated the efficacy of the curriculum. Nearly 91% of respondents without formal programs identified lack of local faculty expertise or interest as the primary barrier to implementing patient safety curricula. Of programs without formal curricula, 93.6% included at least one component of patient safety training in their fellowship programs. The majority of respondents would implement a standardized patient safety curriculum for pediatric EM if one was available. Conclusions Despite the importance of patient safety training and requirements to train pediatric EM fellows in patient safety and medical errors, there is a lack of formal curriculum and local faculty expertise. The majority of programs have introduced components of patient safety training and desire a standardized curriculum. Resumen Objetivos El Accreditation Council for Graduate Medical Education exige formación en seguridad del paciente y errores médicos, pero no proporciona especificaciones de los contenidos o los métodos. Se encuestó a los directores del programa de posresidencia en Medicina de Urgencias y Emergencias ( MUE ) Pediátrica para caracterizar acerca de la formación actual de los adjuntos de MUE Pediátrica en seguridad del paciente, para intentar determinar la necesidad de formación adicional. Metodología Se encuestó mediante correo electrónico a los directores del programa de posresidencia de MUE Pediátrica de junio de 2013 a agosto de 2013. Resultados De los 71 respondedores elegibles de la encuesta, 57 (80,3%) la completaron. Existía un plan de estudios formal en un 24,6% de los programas, con una mediana de 6 horas (rango de 1 a 18 horas) dedicadas en el plan de estudios. Un programa evaluó la eficacia del plan de formación. Casi un 91% de los respondedores sin un programa formal identificó una falta de experiencia o interés de los profesores locales como la barrera principal para implementar un plan de estudios sobre la seguridad del paciente. De los programas sin un plan de estudios formal, un 93,6% incluyó al menos un componente de formación en seguridad del paciente en su programa de posresidencia. La mayoría de los respondedores implementarían un plan de estudios estandarizado sobre seguridad del paciente en MUE Pediátrica si existiera alguno disponible. Conclusiones A pesar de la importancia de la formación en seguridad del paciente y los requisitos para formar a los adjuntos de MUE Pediátrica en seguridad del paciente y errores médicos, hay una falta de plan de estudios formal y de experiencia de profesores locales. La mayoría de los programas ha introducido componentes de formación en seguridad del paciente y desean un plan de estudios estandarizado.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108264/1/acem12418.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/108264/2/acem12418-sup-0001-DataSupplementS1.pd

Happy farming programme : an exploratory study from an intergenerational perspective

Background: To extend the successful experience learnt from the Golden Organic Farming Programme in Tsuen Wan organized by Produce Green Foundation in 2004, a new farming programme entitled “Happy Farming” has been launched in Tuen Mun. A plot of land was leased to Good Tiding Church of Christian National’s Evangelism Commission in Lai Wai Tuen Mun (屯門泥圍佳音福音堂) by the Government. APIAS was invited to design and implement the farming programme in January 2005. Nine volunteers were recruited, including five older people and four youngsters to work together on farming activities including land exploitation, trainings, ploughing, weeding and mass activities such as opening day and harvest day so that intergenerational cooperation and communication could be promoted. By the experience where joint effort is needed, it is expected that the intergenerational programme could bring a certain amount of happiness to the participants. Objectives: In order to get a better understanding of the ways farming activities could enhance happiness of the participants and promote intergenerational relationships, an exploratory study on the impacts of farming will be investigated. To make it more specific, the research objectives are addressed as follows: To explore the way(s) of intergenerational cooperations and communications during farming activities; To investigate the association of farming activities towards the increase in happiness of the participants (the old and the young); To identify an effective programme intervention strategy to promote intergenerational support and psychological well-being (happiness) for policy makers