Assessment of patient satisfaction with the preoperative anaesthetic evaluation

Preoperative anaesthetic evaluation is important in the perioperative care. The aim of the study was to evaluate the level of satisfaction and factors affecting patient satisfaction in the preanaesthetic clinic (PAC). A total of 304 patients who attended PAC for preoperative evaluation were recruited into this study. A bilanguage validated Patient Satisfaction Survey in English and Bahasa Malaysia with total questions of 18 examining non-provider factors (NPF) (facilities and appropriateness of waiting time) and provider factors (PF) (doctor, counter services, nurses and supporting staff) were utilized. The survey form was graded in a strongly agree/ disagree five-point Likert scale format for patients’ level of satisfaction. Overall satisfaction of preoperative evaluation was reported as 98.7% with mean scores from doctor (4.49 + 0.60), counter service (4.48 + 0.61), support staff (4.47 + 0.62) and the NPF (4.40 + 0.62), respectively. All factors were found to be significantly correlated with the overall patients’ satisfaction (p<0.001) and waiting time shown to be the independent predictor affecting the level of satisfaction. Overall majority of the patients were satisfied with the preoperative evaluation provided at PAC and both non-provider and provider factors were shown to have a significant impact on patient satisfaction

A comparison between continuous indirect calorimetry and single weight-based formula in estimating resting energy expenditure in nutritional therapy: a prospective randomized controlled study in critically ill patients

Optimal nutritional therapy is important to improve outcome in critically ill population in an intensive care unit (ICU). Although indirect calorimetry (IC) is currently a gold standard for resting energy expenditure (REE) measurement, yet it is still not routinely used in the ICU. A total of 146 mechanically ventilated patients were randomised to receive enteral nutrition (EN) with energy targeted based on continuous indirect calorimetry (IC) measurements (IC group, n=73) or according to 25 kcal/kg/day (SWB group, n=73). Patient characteristics were equally distributed and the IC group showed lower mean measured REE (1668.1 + 231.7 vs 1512.0 + 177.1 kcal, p<0.001). Results also showed a significant deficiency in the daily (-148.8 + 105.1 vs. -4.99 + 44.0 kcal, p<0.001) and total cumulative energy balances (-1165.3 + 958.1 vs. 46.5 + 369.5 kcal, p<0.001) in the SWB group as compared to the IC group. From the Kaplan-Meier survival analysis, we found that ICU mortality was significantly lower in the IC group with better survival probability compared to the SWB group (log-rank test, p = 0.03). However, both groups showed comparable results in terms of ICU length of stay, duration of mechanical ventilation and incidence of feeding intolerance. In conclusion, this study showed that tightly supervised nutritional therapy based on continuous IC measurement provides significantly less mean daily and cumulative energy deficits as well as significantly reduced ICU mortality rate

A fatal case of cerebral malaria complicated with Gemella bergeri bacteremia: role of Plasmodium mitochondrial cox3 gene and MALDI-TOF mass spectrometry for species identification

Here, we described a fatal case of a 37-year-old returning traveller from Burkina Faso, West Africa, who presented with an acute fitting episode later diagnosed as cerebral malaria induced by Plasmodium falciparum based on microscopic examination and Plasmodium mitochondrial cytochrome c oxidase III (cox3) gene PCR target. Unfortunately, the patient passed away due to severe malaria with multi organ failure complicated with Gemella bergeri bacteremia. G. bergeri was identified using MALDI-TOF mass spectrometry

Ultrasound-Determined Residual Gastric Volume after Clear-Fluid Ingestion in the Paediatric Population: Still a Debatable Issue

Background: Current fasting guidelines are often exceeded in clinical practice, resulting in stressful events during anaesthesia in children. This prospective study compares residual gastric volume after 1 versus 2 h of clear fluid ingestion in fasted children. METHODS: A total of 106 patients were enrolled in the study. Ultrasonography (USG) of gastric antrum (GA) was performed in the supine and right lateral decubitus (RLD) positions. All children fasted from solid food for 6 h. Blackcurrant flavoured drink (3 mL/kg) was given following the measurement of baseline (T0) USG of GA, with follow-ups after 1 (T1) and 2 (T2) hours post-ingestion. Residual gastric volume (RGV) was calculated from the cross-sectional area of GA using a standard formula. Parental satisfaction with their children&rsquo;s behaviour concerning fasting time was recorded. Results: RGV was significantly higher at T1 compared to T2 (p &lt; 0.001). No significant difference was seen between T0 and T2 (p = 0.30). Parental satisfaction was similar at T1 and T2 (p = 0.158). Conclusions: The RGV in paediatric patients after 1 h of clear fluid ingestion was significantly higher than after 2 h of ingestion. There was no difference observed in parental satisfaction concerning the two intervals of fluid fasting. RLD and supine positions can be used reliably to measure the RGV in children

Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury

Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital

Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016&ndash;2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p &lt; 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5&ndash;8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue