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Fulltext Outcome of early cardiopulmonary resuscitation in out-of-hospital cardiac arrest managed in Universiti Kebangsaan Malaysia Medical Centre

Ismail, A.K., Md Jawi, M.I., Mohd Salleh, N.I., Hamdan, N.A., Md Jamal, S., Shah, S.A., et al.

Medicine & Health, 2016;11(1):38-46.
MyJurnal

Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary
resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at
Emergency Department (ED) increases the chance of survival from sudden cardiac
arrest. The main objective of this study was to identify the factors that influenced
the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC). The second objective was to determine the incidence
of CPR initiated by the public prior to ambulance arrival. The present study was a
one-year cross-sectional study. The OHCA patients were identified from the ED
resuscitation logbook. Patients’ medical records were used to obtain details of the
resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene
CPR, use of automated external defibrillators (AEDs), mode of transportation and
the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical
data was analysed using chi-square and Fisher exact tests. Nine patients out of 98
had early CPR. Three patients achieved ROSC. Gender was significantly associated
with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC
compared to those who received late CPR. The provision of early CPR and usage
of AEDs by the public is still low. Female gender had a positive influence on ROSC.
Efforts are required to increase the awareness and involvement of the public in
initiating early CPR prior to the arrival of ambulance service.
Fulltext Evaluation of acute asthma management among emergency doctors using simulation-based assessment

Nagaretnam B, Md Jamal S, Abu Bakar A, Zaini IZ, Saiboon IM

Medicine (Baltimore), 2023 Jul 14;102(28):e34095.
PMID: 37443513 DOI: 10.1097/MD.0000000000034095

Assessment of asthma management competency using conventional methods remains challenging. This study aimed to explore the baseline knowledge, diagnosis accuracy and clinical management accuracy of acute asthma among emergency doctors using simulation-based assessment. We conducted a cross-sectional study involving 65 emergency department medical officers at a tertiary center. Participants were evaluated using 2 components: knowledge assessment of acute asthma and clinical performance assessment. Knowledge was evaluated using a standardized knowledge questionnaire. Clinical performance in managing acute asthma was assessed using a simulated acute asthma scenario and a standardized asthma management checklist using real-time assessments. The mean knowledge score was 14.69 ± 2.16. No significant differences were found in diagnosis and management accuracy in relation to knowledge (H = 0.644, P = .725, df = 6; H = 1.337, P = .512, df = 2). Acute-asthma attacks of all severities were poorly assessed, with accuracies of 27.3, 41.9, and 20.1% in mild, moderate, severe, and life-threatening cases, respectively. However, all participants provided high-quality treatment (accuracy = 82.3%) regardless of severity. Knowledge score does not influence the ability to differentiate asthma severity and management accuracy according to established asthma guidelines. The overall treatment accuracy was high, regardless of the severity of asthma. However, assessment of acute asthma requires further refinement.
Fulltext Comparison of clinical and laboratory characteristics between severe and non-severe dengue in paediatrics

Idrus NL, Md Jamal S, Abu Bakar A, Embong H, Ahmad NS

PLoS Negl Trop Dis, 2023 Dec;17(12):e0011839.
PMID: 38113250 DOI: 10.1371/journal.pntd.0011839

BACKGROUND: The timely identification of severe dengue in peadiatric patients is of utmost importance, as any delay in diagnosis could lead to an irreversible state of shock potentially leading to fatal consequences. The primary aim of our study was to characterize dengue severity in paediatric patients based on initial symptoms, signs, and laboratory investigation of their presentation in the emergency department.
METHODOLOGY: We conducted a retrospective data retrieval from the medical records of 254 paediatric patients who had been diagnosed with confirmed cases of dengue fever. The clinical characteristics were compared between severe and non-severe dengue. Multiple logistic regression analysis was utilised to elucidate the variables that exhibited associations with severe dengue.
RESULTS: A total of 254 paediatric patients were included, among whom 15.4% (n = 39) were diagnosed with severe dengue. Multiple logistic regression analysis identified lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly were independently associated with severe dengue.
CONCLUSION: In paediatric patients, severe dengue is associated with specific clinical indicators, including lethargy, low systolic blood pressure, prolonged capillary refill time (CRT), and the presence of ascites and hepatomegaly. Identifying these clinical features early is crucial for primary care physicians, as it enables accurate diagnosis and timely intervention to manage severe dengue effectively.
The use of warning lights and siren by the ambulance crew in the Universiti Kebangsaan Malaysia Medical Centre

Ismail AK, Mohd Salleh NI, Hamdan NA, Mohd Jawi MI, Abdul Razak SN, Md Jamal S, et al.

Eur J Emerg Med, 2012 Dec;19(6):408-9.
PMID: 22343753 DOI: 10.1097/MEJ.0b013e328351e62e
National expert consensus on short-acting beta2-agonist overreliance in asthma care in Malaysia

Ban AY, Taher SW, Muneswarao J, Ho BK, Ahmad R, Pereirasamy L, et al.

J Asthma, 2024 Jul 01.
PMID: 38832793 DOI: 10.1080/02770903.2024.2361780

OBJECTIVE: Inappropriate use of short-acting beta2-agonists (SABA) in asthma has been associated with undesired outcomes. This national expert consensus was developed to increase awareness of SABA overuse and provide recommendations on the ways to eliminate SABA overprescription and overreliance in Malaysia.
DATA SOURCES: This expert consensus was developed by searching the PubMed database, using index terms to identify SABA overuse-related burden and recommendations made in asthma guidelines. Consensus recommendations were made via the Delphi method, involving a Malaysian expert committee comprising 13 healthcare professionals (five pulmonologists, four family medicine specialists, two emergency medicine physicians and two pharmacists).
STUDY SELECTIONS: The articles reviewed include randomized controlled trials, systematic reviews, meta-analyses, observational studies, guidelines, and surveys, with abstracts in English and published up until June 2023. Relevant recommendations were also sourced from verified websites of medical organizations and societies.
RESULTS: Eleven consensus statements were developed, each statement achieving a priori agreement level of at least 70%. The statements reflect SABA overreliance in asthma care, as well as recommendations to eliminate SABA overprescription and overreliance in Malaysia. Supporting evidence in the literature as well as expert committee discussions leading to the development of the finalized statements were elaborated.
CONCLUSION: This national expert consensus discussed the burden of SABA overreliance and made specific recommendations to eliminate SABA overprescription and overreliance in the Malaysian context. This consensus document is anticipated to impart better awareness among Malaysian healthcare providers and contribute to the continuous improvement of asthma care in the country.