A casemix: congestive heart failure readmission rate and its associated factors in a tertiary teaching hospital in Kuala Lumpur

Cardiovascular mortality is within the top five causes of death from non-communicable disease based on World Health Organization profile. Around 20% of heart failure patients are readmitted within 30 days worldwide. Readmission within 30 days for congestive heart failure often related to non-compliant to fluid restriction, natural progression of the disease or pre-mature discharge. The study aims to evaluate the 30 days readmission rate of congestive heart failure in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from the year 2016-2017 using casemix data and to determine the associated factors related to it. Based on the data coding, cost of readmission incurred was calculated. The 30-days readmission rate of heart failure to UKMMC in the year 2016-2017 was 53.5% & 43.5%, higher than the developed countries standard but similar to that of local teaching hospitals. After adjustment, age and level of severity are the only significant associated factors for the 30-days readmission rate. Shorter average length of stay (ALOS) & lower extra-tariff were achieved for readmission of heart failure. Total of RM80,329.73 was saved in the year 2017 from prompt treatment and comprehensive care plan of treating 19.3% level 3 severity patients at level 1 ALOS and tariff-cost. The 30-days readmission rate for heart failure in UKMMC was comparable to local teaching hospitals. The reduction of 30-days readmission rate in 2017 saved much cost, shows good clinical governance and advanced treatment strategy. Casemix can be used to guide budget allocation for the cardiology department of UKMMC

Reliability and validity of the Malay-version Chicago lead knowledge test (CLKT) among parents of preschool children in Malaysia

The primary objective of this study was to validate the Malay-version Chicago lead knowledge test (CLKT). The CLKT was chosen based on thorough literature review followed by a systematic translation. Data collection involved three phases; initial test was done among 70 parents, retest was done at two weeks apart among similar respondents with response rate of 71.4% (n=50), and another test among 60 professional group. The authors performed non-parametric tests since the data was not normally distributed. The non-parametric test results showed no significant mean knowledge score differences in all demographic parameters. The difficulty factor ranged from 0.01 to 0.99. The mean + SD for difficulty factor was 0.52 + 0.32. Half of the 24 items (n=12) had a difficulty factor of less than 0.75. Only one item (item 6) had item-total correlation of less than 0.2 (0.140). The overall Cronbach’s α coefficient was 0.851. No significant difference was detected by the Wilcoxon Signed-Rank Test between the overall score, the test and retest scores for all domains. All domains showed moderate to strong correlation (Spearman’s Correlation: r=0.546 - 0.814, p<0.001). The Mann-Whitney U test showed a significantly higher knowledge score in professional group compared to parent group for all domains and total knowledge score (p<0.001). The Malay-version CLKT was moderately difficult but had a good reliability and validity. Thus, this instrument can be applied in future larger-scale study

The Chicago Lead Knowledge Test-Malay Version: a cultural and linguistic adaptation for the Malaysian population

Knowledge about exposure to lead among children is still not good among parents in Malaysia. The purpose of this study was to translate the English version of the original Chicago Lead Knowledge Test (CLKT) into the Malay (local) language systematically and to suit the background culture and language of this country. The steps of systematic translation followed the International Society for Pharmacoeconomics and Outcome Research (ISPOR) standard which consists of preparation, forward translation, reconciliation, backward translation, backward translation review, harmonisation, cognitive debriefing, review of cognitive debriefing and finalisation, proofreading, and final report. The total number of items remained at 24, where one item was deleted, one item was revised, and one item was added into the instrument. All four themes; general knowledge, exposure, prevention and nutrition in this questionnaire were maintained. The response scale, answer scheme, and the scoring system remained the same. Most of the English items had direct translation to Malay language except for items 5, 7, 12, 20 and 22. The mean (+SD) and interquartile range (IQR) for total knowledge score was 9.50 + 2.45 marks and 5 marks, respectively. The lowest score was 4 marks and the highest score was 13 marks. This was be the first known study to utilise the systematic and standardised approaches in the cross-cultural translation and adaptation of the CLKT in Malaysia. The CLKT’s cultural and linguistic adaptation in Malaysia may contribute to other current research particularly on lead exposure among children