RESUMO
The audit aimed to investigate the availability oforthodontic instruments and materials at Faculty ofDentistry, University of Malaya. The standard was set as100% of instruments and materials should be availablewhen required for orthodontic treatment. The formcomprised of six sections, which listed the commonlyused instruments and materials involved in the proceduresof impression taking, fitting and removal of molar bands,bonding and debonding of orthodontic brackets andactivation of orthodontic appliances. The fifth section listedthe less commonly used instruments and materials and apart for the clinician to list down instruments that wereused but not listed in the form. Whilst the last section is forthe clinician to list down the instruments or materials thatwere not available when requested. A total of 567 formswere completed and it was found that 97.6% instrumentsand 98.6% materials were available. Overall, 22 types ofinstruments were temporary not available with frequencymean of 2.1 (Minimum: 1; Maximum: 7) whilst 6 types ofmaterials were temporary not available with a frequencymean of 2.3 (Minimum: 1; Maximum: 8). In conclusion,majority of the instruments and materials required duringorthodontic clinical sessions were available. The check listof frequently used orthodontic instruments and materialsfrom this audit could aid inventory and help futuremanagement of the material and instruments.
RESUMO
Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.