Cost effectiveness analysis of using different monitoring modalities in treating severe traumatic brain injury (CESTBI) in neuro-ICU, HUSM, Kelantan

Introduction: There are two schools of thought in practicing neurotrauma monitoring for patients with severe traumatic brain injury (TBI); the application of the baseline neuro-monitoring (BNM) and the use of multiple modalities neurotrauma monitoring (M3) which is very expensive. The answer of which of the two monitoring systems is more eflicient and worth doing should be sought. Objective: To determine the cost effectiveness analysis between BNM and M3 monitoring modalities in the management of severe TBI. Methodology: Sixty-two patients with severe TBI admitted to Neuro-ICU, USM who fulfilled the predetermined criteria were selected using systematic random sampling. The macro and micro costing were performed on each of patient. Barthel Index was used to measure physical performance as an outcome six months after discharge. The analyses used were the Independent t- test, ANCOVA, and Repeated Measure ANOVA. Results: The mean total equipment cost of M3 was significantly higher at p = 0.049 (mean difference of RM23.74) after controlling other variables. The mean difference in Barthel Index after six months was significance between the two groups (p = 0.031), patients that were treated with M3 had higher score 163.7 (SD 30.03)J compared to those who were treated with BNM 146.83 (SD 30.36)]. However, the cost-effectiveness ratio of using M3 was significantly lowered (p=O.031) with a mean of RM476.29 was needed to increase a unit improvement in mean Barthel Index compared to RM629.12 if we used BNM. Conclusion: Although M3 is more costly, the outcome of patients treated with M3 was better than that of BNM. Therefore we can conclude that the used of multiple neuro-monitoring was more cost effective than the use of only baseline neuro-monitoring in treating severe traumatic brain injury

Effects of short duration stress management training on self-perceived depression, anxiety and stress in male automotive assembly workers: a quasi-experimental study

To examine the effects of short duration stress management training (SMT) on self-perceived depression, anxiety and stress in male automotive assembly workers, 118 male automotive workers from Pekan, Pahang (n = 60, mean age = 40.0 years, SD = 6.67) and Kota Bharu, Kelantan (n = 58, mean age = 38.1 years, SD = 5.86) were assigned to experimental and control group, respectively. A SMT program consisting of aerobic exercise, stress management manual, video session, lecture, question and answer session, and pamphlet and poster session were conducted in the experimental group. A validated short-form Malay version of the Depression Anxiety Stress Scales (DASS-21) were self-administered before and after the intervention program in the experimental and control group and their time and group interaction effects were examined using the repeated measure ANOVA test. Results indicated that the mean (SD) scores for DASS-Depression (p = 0.036) and DASS-Anxiety (p = 0.011) were significantly decreased, respectively, after the intervention program in the experimental group as compared to the control group (significant time-group interaction effects). No similar effect was observed for the mean (SD) scores for DASS-Stress (p = 0.104). However, the mean (SD) scores for subscales of DASS-Depression (Dysphoria, p = 0.01), DASS-Anxiety (Subjective Anxiety, p = 0.007, Situational Anxiety, p = 0.048), and DASS-Stress (Nervous Arousal, p = 0.018, Easily Upset, p = 0.047) showed significant time and group interaction effects. These findings suggest that short duration SMT is effective in reducing some aspects of self-perceived depression, anxiety and stress in male automotive workers

Prevalence Of Job Strain And Risk Factors For Job-Related Depression In Laboratory Technicians In Hospital Unversiti Sains Malaysia (HUSM) And Kementerian Kesihatan Malaysia (KKM) Hospitals In Kelantan.

A cross-sectional study was conducted to determine the prevalence of job strain and association between high job strain and other risk factors with job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan between June 2001 and February 2002

Severe conjunctivochalasis in association with classic type Ehlers-Danlos syndrome.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: Inferior conjunctivochalasis is common, but is rarely severe enough to require conjunctival excision. This report describes a patient with severe conjunctivochalasis who was subsequently diagnosed with Ehlers Danlos Syndrome, Classic Type. CASE PRESENTATION: A patient suffering from foreign body sensation, frequent blinking and bilateral inferior conjunctivochalasis was referred and treated by topical ocular lubrication. However, no improvement was observed prompting potential excision of conjunctivochalasis. Following patient consultation and clinical diagnosis including hypermobile joints and skin elasticity, poor wound healing and wide scar morphology, Ehlers-Danlos syndrome was confirmed in the patient. CONCLUSION: This case highlights the need for direct patient questioning and provides the first reported association between conjunctiovochalasis and Ehlers-Danlos syndrome

Analyzing human factors in road accidents: TRACE WP5 Summary Report

The main objectives of TRACE WP5 'Human factors' deliverables are: i) To support a better standardization of accident analysis in Europe on a scientific background, ii) To provide operational models and methodological classification grids dealing with 'human factors' aspects involved in road accidents, iii) To promote a comprehensive analysis of the involvement of human beings, going further than the usual 'user-orientated causal analysis' often limited at establishing the driver 'at fault' and without searching for the background reasons of the problems met par road users. Such objectives involve analyzing accidents as the symptom of the difficulties met by drivers in certain driving situations, and as a revelatory of their needs in help. Two questions have to be asked in order to progress in the understanding of accident causation: 1) What are precisely and operationally the human failures in accidents? But also: 2) What are the reasons for these human failures? Keeping in mind that these reasons are of multiple natures and combine most of the time to produce the final event. By so doing, the definition of typical scenarios of 'human error' production can open to the definition of more appropriate countermeasures, well fitted to human needs

Targeted PI3K/AKT/mTOR therapy for metastatic carcinomas of the cervix: A phase I clinical experience.

BackgroundActivated PI3K/AKT/mTOR pathway frequently occurs in metastatic or recurrent cervical carcinomas. However, the clinical benefits of matched therapy, a therapeutic approach targeting a specific mutational abnormality, have not yet been established.MethodsWe analyzed the outcomes of patients with metastatic or recurrent cervical carcinomas who had a test for PIK3CA mutation and/or PTEN loss/mutation, and received ≥1 phase I therapeutic regimen between January 2006 and June 2013.ResultsPatients with adenocarcinoma had fewer PIK3CA mutations (14%), and survived longer (median, 14.2 months) than those with squamous cell carcinoma (48% and 7.2 months; p = 0.016, and 0.001, respectively). Matched therapy targeting the activated PI3K/AKT/mTOR pathway led to a favorable rate of SD ≥ 6 months/CR/PR (53%) and significantly longer progression-free survival (median, 6.0 months) than non-matched therapy (11% and 1.5 months; p = 0.08 and 0.026; respectively). In patients with squamous cell carcinoma of the cervix, the presence of PIK3CA mutations was associated with a significantly longer overall survival (median, 9.4 months) than the absence of PIK3CA mutations (median, 4.2 months; p = 0.019).ConclusionsMatched therapy targeting the activated PI3K/AKT/mTOR pathway provided meaningful clinical benefits. Thus, further evaluation of PI3K/AKT/mTOR pathway targeted therapy is warranted, especially in metastatic or recurrent squamous cell carcinoma

Workplace assessment of naphtha exposure in a tire manufacturing industry.

A qualitative and quantitative workplace assessment was carried out to determine naphtha exposure in a tyre manufacturing industry. A qualitative chemical health risk assessment was conducted to identify naphtha hazard at the workplace. Quantitative assessment using Portable VOC Monitor, Automatic Sampling Pump and personal air sampling pump was used to determine VOC concentrations, organic solvents, and individual air naphtha respectively. The risk rating of naphtha was estimated to be 5. The mean VOC concentration was in the range of 2.43 to 92.93 ppm. Repair area had the highest VOC concentration while the lowest was in the moulding area. Each work station had significant differences for VOC concentrations (p < 0.001). Laboratory analysis found various solvents including 2-methyl pentane, hexane, methyl cyclopentane, heptane, cyclohexane and toluene which were present in the liquid naphtha. Only xylene has been detected in the making and moulding areas with a range of 2 to 5 ppm. Meanwhile, the air naphtha concentrations of the exposed workers were significantly higher than those unexposed. The risk of naphtha exposure was qualitatively significant and not adequately controlled. Naphtha was detected in all work stations since it is the main solvent used. The “Repair Area” was significantly more contaminated than the other area

Toxic effect of naphta exposure on respiratory system among workers in the tyre industry

A cross-sectional study was carried out on workers in a tyre manufacturing industry in Malaysia to determine the effects of naphtha exposure on lung functions and respiratory symptoms. Sixty male workers exposed to naphtha and 42 unexposed workers were selected for this study. Personal air monitoring carried out using solid sorbent tubes and low flow pumps (Model: PAS-500 Personal Air Sampler). Personal air monitoring showed that the mean air naphtha concentration was 28.50 mg/m3, the median was 28.47 mg/m3 and the inter quartile range of 1.27 mg/m3. The range was from 0.19 to 200.51 mg/m3 (PEL is 400 mg/m3). The lung function tests showed in 2 groups for all the 3 parameters (FVC%, FEV1% and FEV1/FVC) were in exposed group 96.16, 85.23 and 0.791 respectively and in Unexposed group was 113.23, 116.28 and 0.903 respectively. The lung function tests showed that there were significant difference in the 2 groups for FVC% (p < 0.001), FEV1% (p < 0.001) and FEV1/FVC% (p =0.002). Multiple linear regression test showed that monthly household income significantly influence the FVC% predicted (b = 0.003, p < 0.001) and FEV1% predicted (b = 0.006, p < 0.001). In conclusion there was an inverse relationship between air naphtha concentrations and lung functions ability. Early impairment of the respiratory system is detected on the workers who are exposed to naphtha which made up of several chemicals

Which factors and situations for human functional failures? Developing grids for accident causation analysis

This report describes the work undertaken in Task 5.2 of the TRACE project. Human failures are explained by factors characterizing the state of the system and of their interactions. A grid of factors which could lead to these human functional failures is given along with a grid of pre-accident driving situations. In addition to this, an overview is included of the background work undertaken to establish a methodology for classification of these factors and situations. Factors related to the ‘User’, ‘Vehicle’ and ‘Environment’ are described and classifications for use at a ‘descriptive’, ‘generic’ and ‘in-depth’ level are determined, to allow analysis at different levels of detail of accident data. These factors and situations will be used along with the Task 5.1 functional failures to help identify typical failure generating scenarios in Task 5.3, and the subsequent analysis of real world accident data in other work packages in TRACE. They will also be a useful basis for future improvements in the collection of accident causation data, avoiding the common over simplification whereby road users are seen as the main reason for the ‘failure’ in the accident scenario

PIK3CA mutations in advanced cancers: characteristics and outcomes.

PIK3CA mutations are frequently diagnosed in diverse cancers and may predict response to PI3K/AKT/mTOR inhibitors. It remains unclear whether they are associated with other characteristics. We analyzed characteristics and outcome of 90 consecutive patients with diverse advanced tumors and PIK3CA mutations and 180 wild-type PIK3CA controls matched by tumor type, gender, and age referred to the Clinical Center for Targeted Therapy. PIK3CA and MAPK mutations (KRAS, NRAS, and BRAF) were analyzed using polymerase chain reaction-based DNA sequencing. The most frequent PIK3CA mutations were E545K (31/90, 34%), E542K (16/90, 18%) in exon 9, and H1047R (20/90, 22%) in exon 20. PIK3CA mutations compared to wild-type PIK3CA were associated with simultaneous KRAS (p=0.047) and MAPK mutations (p=0.03), but only MAPK mutations were confirmed as having an independent association in multivariate analysis. Rates of lung, bone, liver and brain metastases were similar in PIK3CA-mutant and wild-type patients. Patients with PIK3CA mutations treated on trials with PI3K/AKT/mTOR inhibitors had a higher partial/complete response (PR/CR) rate than wild-type PIK3CA patients treated with their best phase I therapy (10/56, 18% vs. 12/152, 8%; p=0.045), but not a prolonged progression-free survival. Patients with H1047R PIK3CA mutations had higher PR/CR rate with PI3K/AKT/mTOR inhibitors compared to wild-type PIK3CA patients treated with their best phase I therapy (6/16, 38% vs. 12/152, 8%; p=0.003). In conclusion, PIK3CA mutations in diverse cancers were not associated with clinical characteristics, but were correlated with MAPK mutations. PIK3CA mutations, especially, H1047R, were associated with attaining a PR/CR to PI3K/AKT/mTOR pathway inhibitors