Seeruphopper4123
Gift giving is generally well-intentioned and graciously accepted to healthcare professionals but it is also one of the concerns that cause an ethical dilemma in health care. Is the gift giving ethically appropriate? Tangible guidance about how healthcare professionals would respond to gift giving is possibly scarce and non-specific. In cases where there is an absence of hospital policy specifying how to treat patients' gifts, healthcare professionals may need to reflect several factors when addressing the dilemmas. This factor includes a reflection on the implications of responding to the gifts.
Appendicitis is common and delayed presentation results in complicated appendicitis with increased morbidity. This study investigates the effect of the Movement Control Order (MCO) during the COVID-19 pandemic on the presentation and severity of appendicitis.
A cross-sectional study including 193 patients diagnosed with appendicitis was conducted at four hospitals in Pahang, Malaysia. Those who presented between 1 February 2020 and 17 March 2020 were included in the pre-MCO group and those between 18 March 2020 and 30 April 2020 in the MCO group. The definitions of simple and complicated appendicitis were based on the Sunshine Appendicitis Grading Score. The primary outcome was the incidence of complicated appendicitis, and the secondary outcomes were length of stay, a composite of surgical morbidities and a composite of organ failure.
A total of 105 patients in the pre-MCO group and 88 in the MCO group were analysed. The incidence of complicated appendicitis was 33% and it was higher in the MCO than in the pre-MCO group (44% versus 23%,
= 0.002). The MCO period was independently associated with complicated appendicitis in the logistic regression (
= 0.001). It was also associated with prolonged length of stay (3.5 days versus 2.4 days,
< 0.001) and higher overall surgical morbidity (19% versus 5%,
= 0.002).
The MCO imposed during the COVID-19 pandemic was associated with a higher incidence of complicated appendicitis and surgical morbidity.
The MCO imposed during the COVID-19 pandemic was associated with a higher incidence of complicated appendicitis and surgical morbidity.
The computerised classification and prediction of heart disease can be useful for medical personnel for the purpose of fast diagnosis with accurate results. This study presents an efficient classification method for predicting heart disease using a data-mining algorithm.
The algorithm utilises the weighted support vector machine method for efficient classification of heart disease based on a binary response that indicates the presence or absence of heart disease as the result of an angiographic test. The optimal values of the support vector machine and the Radial Basis Function kernel parameters for the heart disease classification were determined via a 10-fold cross-validation method. The heart disease data was partitioned into training and testing sets using different percentages of the splitting ratio. Each of the training sets was used in training the classification method while the predictive power of the method was evaluated on each of the test sets using the Monte-Carlo cross-validation resampling technique. The effect of different percentages of the splitting ratio on the method was also observed.
The misclassification error rate was used to compare the performance of the method with three selected machine learning methods and was observed that the proposed method performs best over others in all cases considered.
Finally, the results illustrate that the classification algorithm presented can effectively predict the heart disease status of an individual based on the results of an angiographic test.
Finally, the results illustrate that the classification algorithm presented can effectively predict the heart disease status of an individual based on the results of an angiographic test.
The coronavirus disease 2019 (COVID-19) pandemic has been found to negatively affect medical students' wellbeing. This finding may be related to how medical education is being conducted at present, with online learning replacing face-to-face teaching in many countries. This cross-sectional study aims to assess how the online learning environment is connected to medical students' wellbeing.
A self-administered online questionnaire was distributed to undergraduate medical students at Universitas Indonesia. The study was conducted from September 2020 to February 2021. The questionnaire included a modified version of the Online Learning Environment Scale (OLES) and the Positive Emotion, Engagement, Relationships, Meaning and Accomplishment (PERMA) profiler. GS-0976 order The OLES was used to evaluate students' perceptions of the online learning environment, whereas the PERMA Profiler was used to evaluate students' wellbeing. We validated the questionnaire before distribution. The content validity index was 1.0, with internnd sadness.
Medical students generally enjoyed online learning, although some challenges were presented. The online learning environment was positively associated with students' wellbeing; however, some students expressed negative emotions including loneliness, anxiety, anger and sadness.
This study was designed as a prospective and interventional study that evaluated LigaSure™ haemorrhoidectomies with regional anaesthesia as a daycare procedure.
Patients with third- and fourth-degree haemorrhoids were recruited from the clinic from January 2018 to December 2019. The procedure was performed as a day case under regional anaesthesia. Using a LigaSure
device, excisional haemorrhoidectomies (Milligan-Morgan haemorrhoidectomy) were performed without sutures or an anal sponge. We evaluated wound bleeding, pain and urinary retention per daycare protocols.
A total of 264 patients were enrolled. There were 153 males (57.9%) with a median age of 30 years old (range 16 years old-80 years old). A total of 142 patients (54%) had third-degree haemorrhoids, while the rest had fourth-degree haemorrhoids. The median operating time was 8 min (range 4 min-17 min) and minimal blood loss was observed. During follow-up, the complications were one case (0.3%) had anal stenosis, one case (0.3%) had minimal bleeding and one case (0.3%) had urine retention. Upon discharge, four patients (1.5%) required additional analgesia and another four (1.5%) developed post-spinal headaches. No incontinence was encountered.
LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.
LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.
A good refractive outcome after cataract surgery indicates adequate clinical service provision. Precise immersion biometry is critical to achieve the desired refractive outcome. While the immersion biometry results are good in the tertiary settings, it is of interest to explore the refractive outcome of cataract surgeries in a rural facility using the same technique.
A retrospective cross-sectional review was conducted on medical records of all cataract surgeries carried out in Hospital Keningau, Sabah. This study used all patients' medical records who had been assessed using immersion biometry pre-operatively, underwent phacoemulsification cataract surgery besides attending a post-operative refraction session within 90 days from the operation date. Clinical details were recorded in the form of standard proformas and analysed. The refractive outcome was evaluated using spherical equivalence (SE) and best-corrected visual acuity (BCVA). The percentage of cases with post-operative SE within ±1.00 diopter (D) and BCVA of '6/12 or better' were determined. The association between demographic factors and surgical-related factors with post-operative SE was evaluated using Fisher's exact test.
Of 140 cataract surgeries, 113 fulfilled the inclusion criteria. The average patient age was 66.3 (SD = 10.9) years old. The technique was proven to replicate a good outcome of 84.1% of cases with post-operative SE within ±1.00 D while 90.3% of the cases achieved BCVA of '6/12 or better
. Age and ethnicity were found to be associated with post-operative SE.
The study proves the reproducibility of good refractive outcome in a rural facility using immersion biometry. The findings provide a benchmark for performance surveillance in rural facilities.
The study proves the reproducibility of good refractive outcome in a rural facility using immersion biometry. The findings provide a benchmark for performance surveillance in rural facilities.
To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome.
Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment.
The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent anti-tuberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequ medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value less then 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.
Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy.
This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (
= 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (
= 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (
= 54) 10 min before the end of the operation. At the time of the patients' entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO
were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.
At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (
< 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (
< 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (
< 0.001). Recovery time was the longest for the ketamine-propofol group (
= 0.008).
The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.
The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.
