-
[show abstract]
[hide abstract]
ABSTRACT: Patients with issues or health problems usually plan to discuss their concerns with their health care providers. If these concerns were not presented or voiced during the health care provider-patient encounter, the patients are considered to have unvoiced needs. This article examines the extent and possible determinants of patients' unvoiced needs in an outpatient setting. A cross-sectional study was conducted in 5 Ministry of Health Malaysia primary health facilities throughout the country. Of 1829 who participated, 5 did not respond to the question on planned issues. Of the 1824 respondents, 57.9% (95% confidence interval = 47.1-68.7) claimed to have issues/problems they planned to share, of whom 15.1% to 26.7% had unvoiced needs. Extent of unvoiced needs differed by employment status, perceived category of health care provider, and study center. Perceived category of health care provider, method of questionnaire administration, and study center were the only significant determinants of unvoiced needs. Unvoiced needs do exist in Malaysia and there is a need for health care providers to be aware and take steps to counter this.
Asia-Pacific Journal of Public Health 08/2011; 23(5):690-702. · 1.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Very few registries worldwide focus on clinical outcomes of stem cell therapy (SCT) as the large number of applications and rapid development of the field complicates registry design considerably. The National Stem Cell Therapy Patient Registry of Malaysia aims to accommodate this by using a main protocol which covers the overall design and administration of the registry, and condition-specific sub-protocols which deal with outcome measures. The registry will start with a few sub-protocols covering existing modes of SCT in Malaysia, with new sub-protocols released periodically as the need arises.
Stem cell reviews 12/2010; 6(4):507-11. · 5.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To apply cumulative sum (CUSUM) in monitoring performance of surgeons in cataract surgery and to evaluate the response of performance to intervention.
A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees' CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries.
CUSUM charts of the trainees demonstrated an initial upward followed by flattening trend. This reflects learning curves in their process of acquiring competency in phacoemulsification. In contrast, the consultant showed a flat curve indicating an ongoing maintenance of competence.
The CUSUM analysis is able to monitor and promptly detect adverse events and trends of unacceptable outcomes in cataract surgery. This objective and dynamic monitoring makes CUSUM a useful audit tool for individual surgeons, but more so for busy consultants who need to supervise trainees.
The British journal of ophthalmology 11/2009; 94(4):445-9. · 2.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the accuracy of autorefraction using three autorefractors comparing to subjective refraction in diagnosing refractive error in children.
A cross-sectional study.
setting: Community based study. study population: 117 children sampled from primary schools. procedures: All subjects underwent autorefraction using three auto refractors and subjective refraction with and without cycloplegia. main outcome measures: Spherical power, cylindrical power, and spherical equivalence (SE).
Without cycloplegia, the mean SE were significantly different for Retinomax K plus 2 (-1.55 diopters, SD 2.37 diopters; 95% CI -1.98 to -1.12; P < .0001) and Canon RF10 (-1.11 diopters; SD 2.61 diopters; 95% CI -1.59 to -0.64; P = .0023) compared with monocular subjective refraction (-0.80 diopters; SD 2.25 diopters; 95% CI -1.21 to -0.35). Mean SE was significantly different for Grand Seiko WR5100K (-0.79 diopters; SD 2.40 diopters; 95% CI -1.23 to -0.35; P = .0002) compared with binocular subjective refraction (-0.62 diopters; SD 2.51 diopters; 95% CI -1.07 to -0.16). With cycloplegia, there was no significant difference in mean SE between refraction methods. Sensitivity and specificity results for the diagnosis of myopia: Without cycloplegia: Retinomax K plus 2 (sensitivity 1.0, specificity 0.51); Canon RF10 (sensitivity 0.92, specificity 0.81); and Grand Seiko WR5100K (sensitivity 0.91, specificity 0.98). With cycloplegia: Retinomax K plus 2 (sensitivity 0.97, specificity 0.99); Canon RF10 (sensitivity 0.97, specificity 0.96); and Grand Seiko WR5100K (sensitivity 1.0, specificity 0.97).
Under noncycloplegic conditions, all three autorefractors have a tendency towards minus over correction in children resulting in over diagnosis of myopia. However autorefractors were accurate under cycloplegic conditions.
American Journal of Ophthalmology 08/2006; 142(1):68-74. · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.
Population-based, cross-sectional survey.
Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households.
Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus.
Distance visual acuity and cycloplegic refraction.
The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction.
Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.
Ophthalmology 04/2005; 112(4):678-85. · 5.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE) and phacoemulsification at three hospitals of the Malaysian Ministry of Health (MOH).
Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs were assessed prospectively in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery. Successful surgery was defined as best-corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively.
Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%) than in the ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD 905.79) and phacoemulsification with intraocular lens implant costs RM4288 (USD 1128.42).
There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery in the MOH hospital was found to be high due to the high overhead costs.
International Ophthalmology 04/2004; 25(2):81-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Purpose: To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE)
and phacoemulsification at three hospitals of the Malaysian Ministry of Health (MOH). Methods: Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative
visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week
period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs were assessed prospectively
in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness
refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful
cataract surgery. Successful surgery was defined as best-corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively.
Results: Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%)
than in the ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD905.79)
and phacoemulsification with intraocular lens implant costs RM4288 (USD 1128.42). Discussion: There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery
in the MOH hospital was found to be high due to the high overhead costs.
International Ophthalmology 02/2004; 25(2):81-87.
