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  1. Loch A, Lwin T, Zakaria IM, Abidin IZ, Wan Ahmad WA, Hautmann O
    Postgrad Med J, 2013 Jun;89(1052):335-9.
    PMID: 23524989 DOI: 10.1136/postgradmedj-2012-131174
    INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
    OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
    METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
    RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
    CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
    KEYWORDS: Accident & Emergency Medicine; Quality improvement
    Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur
  2. Min Thein W, Gamini Sirisinghe R, Elsayed Mohamed Ali Abdou I, Samraj Prakash Earnest B, Pwint Phyu K, Lwin T, et al.
    PMID: 38058881 DOI: 10.15694/mep.2020.000046.1
    This article was migrated. The article was marked as recommended. A conducive educational environment is vital to successful learning. Perception of students about their particular educational environment may vary depending on their educational background, gender, level of study, and many other factors. Awareness and understanding of the students' perception of educational environment are a key to improve our teaching and learning environment. The aim of the study was to determine the perception of undergraduate medical students of Taylor's University, Malaysia on their educational environment. A cross sectional cohort study was conducted among preclinical and clinical students simultaneously at Taylor's University, School of Medicine in July 2019. Overall total scores of perceptions (136.55 ± 19.6) and those for the subscales were very satisfactory and similar to those of other local universities as well as international universities. There was a significant difference between preclinical and clinical students in two domains; Perception of Course Organizers and Academic Self-Perception, with higher scores among clinical students in all. There was a significant difference between students with Grade 'B' and those with Grade 'C' in the mean total score and Perceptions of Atmosphere. These results, in spite of being satisfactory, urge us to seek methods of and opportunities for further enhancement of the students' education environment.
  3. Htet AS, Kjøllesdal MK, Aung WP, Moe Myint AN, Aye WT, Wai MM, et al.
    BMJ Open, 2017 Nov 15;7(11):e017465.
    PMID: 29146640 DOI: 10.1136/bmjopen-2017-017465
    OBJECTIVE: The first is to estimate the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, high low-density lipoprotein (LDL) level and low high-density lipoprotein (HDL) level), as well as the mean levels of total cholesterol, triglyceride, LDL and HDL, in the urban and rural Yangon Region, Myanmar. The second is to investigate the association between urban-rural location and total cholesterol.

    DESIGN: Two cross-sectional studies using the WHO STEPS methodology.

    SETTING: Both the urban and rural areas of the Yangon Region, Myanmar.

    PARTICIPANTS: A total of 1370 men and women aged 25-74 years participated based on a multistage cluster sampling. Physically and mentally ill people, monks, nuns, soldiers and institutionalised people were excluded.

    RESULTS: Compared with rural counterparts, urban dwellers had a significantly higher age-standardised prevalence of hypercholesterolaemia (50.7% vs 41.6%; p=0.042) and a low HDL level (60.6% vs 44.4%; p=0.001). No urban-rural differences were found in the prevalence of hypertriglyceridaemia and high LDL. Men had a higher age-standardised prevalence of hypertriglyceridaemia than women (25.1% vs 14.8%; p<0.001), while the opposite pattern was found in the prevalence of a high LDL (11.3% vs 16.3%; p=0.018) and low HDL level (35.3% vs 70.1%; p<0.001).Compared with rural inhabitants, urban dwellers had higher age-standardised mean levels of total cholesterol (5.31 mmol/L, SE: 0.044 vs 5.05 mmol/L, 0.068; p=0.009), triglyceride (1.65 mmol/L, 0.049 vs 1.38 mmol/L, 0.078; p=0.017), LDL (3.44 mmol/L, 0.019 vs 3.16 mmol/L, 0.058; p=0.001) and lower age-standardised mean levels of HDL (1.11 mmol/L, 0.010 vs 1.25 mmol/L, 0.012; p<0.001). In linear regression, the total cholesterol was significantly associated with an urban location among men, but not among women.

    CONCLUSION: The mean level of total cholesterol and the prevalence of hypercholesterolaemia were alarmingly high in men and women in both the urban and rural areas of Yangon Region, Myanmar. Preventive measures to reduce cholesterol levels in the population are therefore needed.

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