Cost of In-patient Management of Covid-19 Patients in a Tertiary Hospital in Kuwait

BackgroundAmong the GCC countries affected by COVID-19 infections, Kuwait was impacted with 658,520 cases and 2,563 deaths as reported by WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on the economy of Kuwait especially in health sector is unknown. ObjectiveThe aim of this study is to determine the total cost of COVID-19 in-patient management in Kuwait. MethodRetrospective design was employed in this study. A total 485 Covid-19 patients admitted to a tertiary hospital assigned to manage Covid-19 cases was randomly selected for this study from 1st May to 31st September 2021. Data on sociodemographic, length of stay (LOS), discharge status and comorbidity were obtained from the patients medical records. Among others, data on cost in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was imputed using a step-down costing method with three levels of cost centers. The unit cost was multiplied by the individual patients length of stay to obtain the cost of care per patient per admission. FindingsThe mean cost of Covid-19 inpatient per episode of care was KD 2,216 (SD=2,018) equals to US$ 7,344 (SD=6,688) with the average length of stay of 9.4 (SD=8.5) days per admission. The total treatment costs of Covid-19 inpatient (n=485) were estimated to be KD 1,074,644 (US$ 3,561,585), in which the physician and nursing care cost were the largest share of costs (42.1%) with KD 452,154 (US$ 1,498,529). The second- and third-largest costs were intensive care (20.6%) of KD 221,439 (US$ 733,893) and laboratory costs (10.2%) of KD 109,264 (US$ 362,123). The average cost for severe Covid-19 patient was KD 4,626 (US$ 15,332), which is almost three times higher than the non-severe patients of KD 1,544 (US$ 5,117). ConclusionThe cost of managing Covid-19 cases is substantial. The cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for the management of high-risk groups.

Incidence of COVID-19 reinfection: an analysis of outpatient-based data in the United States of America

ObjectivesCOVID-19 reinfection cases are evidence of antibody waning in recovered individuals. Previous studies had reported cases of COVID-19 reinfection both in hospital-based and community-based data. However, limited studies reported COVID-19 reinfection in large community-based data. The present study aimed to provide the incidence of COVID-19 reinfection based on secondary data in the U.S. Study designCross-sectional study MethodsA cross-sectional study was conducted using secondary data provided by COVID-19 Research Database, i.e., Healthjump. Reinfection were defined as diagnosed COVID-19 (U07.1= confirmed virus identified) twice with [≥]90 days interval between diagnosis. Age, gender, and region data were also explored. A Chi-square test continued by a binary logistic regression was conducted to determine the association between parameters. Data collecting and processing were done in the Amazon workspace. ResultsThe study revealed 3,778 reinfection cases of 116,932 COVID-19 infected cases (3.23%). Reinfection cases were more common in females (3.35%) than males (3.23%). Elderly subjects were the highest incidence (5.13%), followed by adult (4.14%), young adults (2.35%), and children (1.09%). Proportion in the region of living northeast was the highest (3.68%), compared to the south (3.49%), west (2.59%), and midwest (2.48%). ConclusionThe incidence of COVID-19 reinfection was 3.23%, suggesting our concern with COVID-19 management and future research to understand COVID-19 reinfection better. The incident is more likely to occur in female and elderly patients.

Keberhasilan Pemulihan dalam Komuniti dan faktor berkaitan dengannya dalam kalangan kanak-kanak kurang upaya di Pantai Timur Semenanjung Malaysia (Outcome of Community-based Rehabilitation and its Associated Factors among Children with Disability in East Coast of Peninsular Malaysia) / Jurnal Sains Kesihatan Malaysia

@#Children with disability require comprehensive and continuous rehabilitation. Community-based rehabilitation (CBR) was developed to fulfil this need and has benefited children of various ages both in the rural and urban societies. In Malaysia, the government largely fund rehabilitation of children at the CBR centers. However, to date research data on the outcome of CBR on children with disability in the country is scarce. This study was intended to determine the outcome of CBR and its associated factors among children with disability. Outcome of rehabilitation was determined with regard to changes in activity of daily living ability with the use of the Barthel Index at 6 months post-CBR. Analysed factors were age, baseline score of the Barthel Index, frequency of attendance in therapy sessions and number of therapy received. Data was analysed using paired t test, Wilcoxon signed ranks test and Spearman correlation test. A total of 220 children with disability aged 4 to 18 years and 220 caretakers from 29 selected CBR centres in Pahang, Terengganu and Kelantan participated in this study. The results showed a small increase in the Barthel Index score of the children, with mean change ± SD equals 0.90 ± 4.54 (p=0.003) following rehabilitation. Attendance to therapy sessions was low, with <50% attended three quarter or more sessions of the total sessions offered. No analysed factors were found to be associated with the change in the Barthel Index (p>0.05). As a conclusion, the outcome gained through CBR is too small for the duration of rehabilitation implemented. The delivery of CBR program need to be reviewed and enhanced to improve its effectiveness on children with disability.

Recurrent SARS-CoV-2 RNA positivity after COVID-19: A systematic review and meta analysis

BackgroundPrevious studies reported recurrent SARS-CoV-2 RNA positivity in individuals who had recovered from COVID-19 infections. However, little is known regarding the systematic review of recurrent SARS-CoV-2 RNA positivity. The current study conducted a systematic review and meta-analysis, aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. MethodsWe searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2. ResultsFourteen studies of 2,568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.81% (95% confidence interval [CI]: 11.44-18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.44 days (95% CI: 32.65-38.24 days), and from the last negative to recurrent positive result was 9.76 days (95% CI: 7.31-12.22 days). Patients with younger age (mean difference [MD]=-2.27, 95% CI: -2.95 to -1.80) and a longer initial illness (MD=8.24 days; 95% CI: 7.54 - 8.95; I2=98.9%) were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes (RR=0.52; 95% CI: 0.30-0.90; I2=53%), severe disease (RR=0.54; 95% CI: 0.35-0.84; I2=70%), and a low lymphocyte count (RR=0.58; 95% CI: 0.39 - 0.86; I2=48%) were less likely to experience recurrent SARS-CoV-2 positivity. ConclusionsThe incidence of recurrent SARS-CoV-2 positivity was 14.81%. The estimated interval from disease onset to repeat positivity was 35.44 days, and the estimated interval from the last negative result to recurrent positive result duration was 9.76 days.

The Economic Burden Of Frailty Among Elderly People: A Review Of The Current Literature

@#Life expectancy from birth is increasing dramatically. Due to this increase, the population of elderly people will increase. Consequently, geriatric related illnesses will increase leading to increased necessity to build up comprehensive and coordinated cost effective health care services appropriate for elderly people. Frailty is not a disease, but rather considered as a syndrome requiring comprehensive and multidisciplinary care approach. It is a prevalent reversible pathological transitional stage between healthy aging and disability. Frailty is associated significantly with increased health care utilization, mortality, and comorbidities such falls, hospitalizations, physical dependence, and poor perception of health. The aim of this review is to compile existing literature on the economic cost of frailty syndrome among elderly people in the recent years. Search queries were constructed to look for articles related to the economic cost of frailty in the electronic databases available at the National University of Malaysia library for articles published between the years 2011 and 2019. The accessed electronic database included New England journal of medicine, Science Direct, SCOPUS, BMJ, Cochrane, and Wiley Online Library. Articles included in this review when they were original research, participants were defined as frail elderly, manuscripts written in English language, and involved clearly described measures of frailty cost. Among the literature, twenty one articles were found to satisfy the inclusion criteria of the review process. The cost of care for frail elderly was ranging from US $ 8,620 to 29,910 per patient per year. The cost of health care was ranging from US $ 2,540 to 221,400. The health care cost was accounting for 40% to 76% of the total care cost. Hospitalization cost was the highest, it was ranging from US $ 806 to 152,726. Outpatient cost was ranging from US $ 200 to 18,000. Medications cost was ranging from US $ 7 to 3,434 per frail elderly patient per year. Home help cost was ranging from US $ 804 to 19,728 per frail elderly patient per year. In conclusion, frailty is a costly syndrome. It can be considered as a cost effective target for health promoting interventions to contain future elderly cost.

Leadership Styles Of Military Hospital Managers In Malaysia And Its Influencing Factors

@#A good quality leader is vital in ensuring effective and efficient services rendered to patients. However, as to date, little is known on the leadership styles of managers in Military Hospitals in Malaysia and the region. The aim of this cross-sectional study was to determine the leadership styles and identify the influencing factors, among Military and Non-Military managers in five Military Hospitals in Malaysia. A pre-tested 20-item questionnaire was distributed to eligible managers in the hospitals. Based on the total score, the leadership style of managers was classified into Transformational (TS) and Non-Transformational style (N-TS). Among the 501 respondents, 375 (74.9%) of them were Non-military managers and 126 (25.1%) of them were Military managers. 46.8% (n=59) of the managers with military background practiced TS while only 27.7% (n=104) of Non-military managers have TS (X2 =15.662; p <0.001). Managers aged 40 years and above, male, with higher educational level, served longer in the service, attended in-service training and participated in other capacity building activities were more likely to practice TS. Analysis using stepwise multiple logistic regressions proved that predictors of TS style are educational level (AOR=2.319; 95% CI=1.300,4.134), working experience (AOR=1.075; 95% CI=1.049,1.102), Military managers (AOR=1.759; 95% CI=1.104,2.802) and attended in-service training (AOR=2.070; 95% CI=1.369,3.129). In conclusion, the Military Hospitals have the benefit of being managed by Military managers that practice TS. Educational level and in-service training are two most important elements that influence the practice TS among the managers in these Military Hospitals.

The Impact of Casemix Reimbursement on Hospital Revenue in Indonesia (Kesan Pembayaran Casemix pada Pendapatan Hospital di Indonesia) / Jurnal Sains Kesihatan Malaysia

@#The objective of this study is to examine the impact of the casemix reimbursement on the hospital revenue at three selected hospitals (Type B, C and D) reimbursed using 602 groups from 14,749 cases. The results of the study showed that the hospitals received 32.4% higher income when reimbursed with Indonesia Case Bases Groups (INA-CBG) as compared to fee-for-service. Type D hospitals is the biggest gainer with 81.0% increased in income followed by Type B hospital that obtained 34.7% higher revenue. In conclusion, the use of INA-CBG as a prospective payment method has benefitted the hospitals by the increase in the revenues. It is hope that additional resources gained in this programme will allow the hospitals to provide optimum care to the population. It is recommended that the JKA management will use the INA-CBG casemix data to monitor the performance of the hospitals to ensure that quality and efficiency of the services provided to the population is continuously maintained.

The uptake of Mammogram screening in Malaysia and its associated factors: A systematic review

Introduction: This review aimed to summarise the trend ofmammogram screening uptake published in local studiesbetween years 2006 and 2015 among the Malaysian womenaged 40 years and above, and identify the associated factorsand barriers, as well as discuss limitations of the studiesand research gaps.Methods: A systematic review was conducted on breastcancer screening studies among Malaysian women,published between January 2006 and December 2015.Online databases were searched using keywords:“mammogram”, “mammography”, “uptake”, “breast cancerscreening” and “Malaysia”.Results: Thirteen original articles were reviewed. The rate ofmammography uptake ranged between 3.6% and 30.9%among the general population, and 80.3% among personnelof a tertiary hospital. Factors associated with mammogramscreening were clinical breast examination, age, income,knowledge on breast cancer and mammogram, perceivedsusceptibility to breast cancer, ethnicity and education level.Barriers to mammogram screening were lack of knowledge,embarrassment, fear of cancer diagnosis, perception thatbreast screening was unnecessary, lack of coping skills andpain during procedure. However, almost all of the studiescould not be generalised beyond the study sample becauseof the limited number of sites and respondents; and mostdata were self-reported with no objective measures of theresponses.Conclusion: Mammogram screening uptake among womenin selected communities were generally low. Further studiesinvolving the general population are essential. Futurestudies should also explore the availability, affordability andaccessibility of this service especially in the pursuit ofachieving universal health coverage in breast cancermanagement.

The Cost of Radiology Procedures Using Activity Based Costing (ABC) for Development of Cost Weights in Implementation of Casemix System in Malaysia / Jurnal Sains Kesihatan Malaysia

@#Presently there is a gross lack of information on cost and cost weights in many developing countries that implementcasemix system. Furthermore, studies that employed Activity Based Costing method (ABC) to estimate the costs of radiologyprocedures were rarely done in developing countries, including Malaysia. The main objective of this study is to determinethe costs of radiology procedures for each group in casemix system, in order to develop cost weights to be used in theimplementation of the casemix system. An economic evaluation study was conducted in all units in the Department ofRadiology in the first teaching hospital using the casemix system in Malaysia. From the 25,754 cases, 16,173 (62.8%)of them were from medical discipline. Low One Third and High One Third (L3H3) method was employed to trim theoutlier cases. Output from the trimming, 15,387 cases were included in the study. The results revealed that the totalinpatients’ charges of all the radiology procedures was RM1,820,533.00 while the cost imputed using ABC method wasRM2,970,505.54. The biggest cost component were human resources in Radiology Unit (Mobile) (57.5%), consumables(78.5%) of Endovascular Interventional Radiology (EIR) Unit, equipment (81.4%) of Magnetic Resonance Imaging (MRI)Unit, reagents (68.1%) of Medical Nuclear Unit. The one highest radiology cost weight, was for Malaysia DiagnosisRelated Group (MY-DRG®)B-4-11-II (Hepatobiliary and Pancreas Neoplasms with severity level II, 2.8301). The methodof calculation of the cost of procedures need to be revised by the hospital as findings from this study showed that the costimposed to patient is lower than the actual cost.

Systematic Review Of Factors Associated With Willingness To Pay For Health Financing Scheme

@#Health care has emerged as one of the fastest growing industry worldwide. This induced health care costto rise tramendously. However, it is important to preserve high quality health care services that are equitable and affordable. In many countries, people are expected to contribute to the cost of the health care. Are populations ready to accept the concept and willing to pay for health financing scheme? What possible factors that may associate with their decision? This is the objective of the study, to examine the relevance evidence for this through a systematic review of literatures.We systematically searched Ovid MEDLINE and Google Schoolar databases until April 2016. We assessed the study population willingness to pay for health financing scheme and determine the significant variables that associate with WTP. 19 full-text articles were included in the review. Factors that were found significantly associated with WTP for health financing scheme by many studies were age, education, income and residential locality. Other factors that also found associated with WTP were health care services utilization and expenditure. The review findings showed that WTP for health financing scheme is beyond the households’ financial capacity and has multifactorial influences.

Provider Costs Of Treating Dementia Among The Elderly In Government Hospitals Of Malaysia

@#he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.

Estimation Of Cost Of Diagnostic Laboratory Services Using Activity Based Costing (ABC) For Implementation Of Malaysia Diagnosis Related Group (My-Drg®) In A Teaching Hospital

The Malaysia Diagnosis Related Group (MY-DRG®), established since 2002, is a patient classification system that stratifies disease severity and categories patients into iso-resource groups. Casemix can be used to estimate costs per episode of care and as a provider payment tool in health services. Casemix has also been used to enhance quality and improve the efficiency of health services. Hence, estimation cost per DRG is important especially in developing countries where costing data are still scarce. We embarked on a study to determine the costs of the diagnostics laboratory services for each MY-DRG® based on the severity of illnesses. Most costing studies for diagnostic laboratory services usually focus on the cost of consumables and equipment alone and employed the step-down costing method. Very few studies applied Activity-Based Costing (ABC) method to estimate the costs for diagnostic laboratory services. This study was done with the purpose of developing the diagnostics laboratory cost using the ABC method. All medical cases discharged from UKM Medical Centre (UKMMC) in 2011 grouped into MY-DRG® were included in this study. In 2011, a total of 2.7 million diagnostic laboratory investigations were carried out in the Department of Diagnostic Laboratory Services in UKMMC. ABC was conducted from January to December 2013 in all units of the department. Cost of 242 types of diagnostic laboratory services were collected using a costing format. Out of 25,754 cases, 16,173 (62.8%) cases were from the medical discipline. After trimming using L3H3 method, 15,387 cases were included in the study. Most of the cases were on severity level one (44.6%), followed by severity level two (32.3%) and severity level three (23.1%). The highest diagnostic laboratory service weight was for Lymphoma & Chronic Leukemia, severity level III (C-4-11-III) with the value of 5.9609. Information on seven cost components was collected form each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results revealed that, the biggest cost component for human resources was in Molecular Genetic Unit (89.6%), consumables (34.8%) from Tissue Culture Unit, equipment (11.2%) and reagents (68.1%) from Specialized Haemostasis Unit. In conclusion, the accurate and reliable cost of the diagnostic laboratory services can be determined using ABC. Top management of the department should be able to use the output of the study to take appropriate steps to reduce unnecessary wastages of resources in the various units of the services.

Global Economic Burden Of Asbestos Related Diseases In Comparison With The Costs Of Production And Consumption

Occupational cancers, including mesothelioma and lung cancer are linked to the use of asbestos. Annually, at least 100,000 global deaths are attributed to asbestos exposure putting a heavy burden on national budgets. Expenses incurred on treatment of asbestos related diseases (ARDs) reduce households and national resource savings, while ARDs culminate in terminal burdens. The objective of this study is to measure the economic burden of ARDs and to assess the economic impact of asbestos consumption. The health and economic burden of asbestos was estimated in macro-global consumption-production model using production function frontier-based and generalized least squared approach for asbestos products and cost tabulation. Production, in metric tons (Mt) was adopted as a dependent variable among explanatory variables, including consumption. Information on treatment cost of asbestos related diseases (mesothelioma, asbestosis and lung cancer) was obtained from costing information and published literatures. Annual total economic burden of asbestos is at USD 11.92 billion. Out of this cost, USD 4.34 billion per annum is the economic burden of managing three common ARDs. The cost of compensation for patients suffering ARDs is USD 4.28 billion. From the remaining USD 3.3 billion, USD 2.93 billion is the value of asbestos consumed in 2003 and USD372.15 million is the loss of earning due to hospital visits and admissions. For every USD 1 spent on consumption of asbestos, global economy has to absorb almost USD 4 due to health consequences of ARDs. Banning of asbestos production and usage in production of goods has far-reaching impacts on household welfare, health and economic development. The insights revealed are expected to inform decision makers the need to ban all forms of asbestos, especially in developing countries where usage is increasing.

Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community

Purpose: this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community. Methods: A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients’ medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL). results: A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were ‘energy’ and ‘social role’. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01). conclusions: It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.

The Introduction Of Subsidised Health Insurance For The Poor In The City Of Padang, Indonesia: Does The Gap On Health Payment And Health Service Utilisation Still Exist?

Indonesian government secures the access of the poor towards health services through subsidised schemes. This study is aimed to describe the pattern of health expenditure by households and to describe the pattern of health service utilisation across household’s socioeconomic level in the city of Padang after seven years of the introduction of subsidised schemes. A household survey was conducted involving 918 households, with multistage random sampling method. The proportion of out-of-pocket (OOP) health spending as a share of household’s capacity to pay was regressive across consumption quintiles. The proportion of households with catastrophic health expenditure was 1.6% while 1.1% faced impoverished health expenses. Among those who need health care, the utilisation among the rich was higher than the poor. Health insurance schemes in Padang provides financial protection, however with regards to household’s capacity to pay, the poor has the higher burden of health payment. The gap on health service utilisation between the poor and the better-offs was still apparent for outpatient services and it has been narrowed for inpatient care. This study suggests that the subsidised schemes for the poor are highly needed and the possibility of the leakage of subsidies to the rich should be considered by the government.

The Gap Between Knowledge And Perception On Education In Traditional And Complementary Medicine Among Medical Staff In Malaysia

Although the Ministry of Health Malaysia has been encouraging the practice of Traditional and Complementary Medicine (T&CM)1, 2, 3, 4 but patients/clients has not been able to apply it for their need of medical treatments and sometimes it leads to negative outcomes due to lack of knowledge on T&CM and its safe applications5,6’7,8 Most of the western-trained physicians are ignorant of risk and benefits of T&CM9,10,11. This study was aimed to determine the gap between knowledge regarding T&CM and perception on education in T&CM among the medical staffs in five selected hospitals in Malaysia. A cross-sectional survey was done at five public hospitals among medical staff in Malaysia by using quantitative methods. A total of 477 medical staffs were involved in this study. The study showed that the overall knowledge of T&CM among the medical staffs were poor (61.2%). Having good knowledge regarding T&CM were significantly higher in Hospital Duchess of Kent (52%, p=0.001), among the non-Malays (44%, p=0.047) and pharmacists (47.2%, p=0.030). Positive perception on health education in T&CM among medical staffs were high (85.3%) especially among females (88.1%, p=0.002) and pharmacists (93.7%, p<0.001). The use of T&CM among the general population is relatively high in Malaysia and many patients increasingly seek the information on T&CM therapies from medical staffs. Knowledge regarding T&CM was poor in this study because most of the medical staffs have not been exposed to T&CM education. This interesting scenario between poor knowledge and high positive perception on health education in T&CM shows the demand of urgent intervention in educating the medical staffs. We recommend that medical staffs must have some basic education and knowledge about T&CM before they could offer advice to their patients. Doctors are of the utmost important in this regard because they play a very important role in patient care. Providing T&CM education to medical staff may help to integrate T&CM into the mainstream medicine.

Development Of Clinical Pathway For Mild Cognitive Impairment And Dementia To Quantify Cost Of Age-Related Cognitive Disorders In Malaysia

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

Skeletal-related events among breast and prostate cancer patients: towards new treatment initiation in Malaysia's hospital setting.

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient health- related quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.

Periodontal Status And Provision Of Periodontal Services In Malaysia: Trends And Way Forward

The paucity of published literature on periodontal treatment needs and services in developing countries has undermined the significance of periodontal disease burden on healthcare systems. This study analyses periodontal status and population treatment needs of Malaysians, and patterns of periodontal services provided at public sector dental clinics. A retrospective approach to secondary data analysis was employed. Data for population treatment needs were extracted from three decennial national oral health surveys for adults (1990, 2000 and 2010). Annual reports from the dental subsystem of the government Health Information Management System (HIMS) provided information on oral health care delivery for years 2006-2010. They were based on summaries of aggregated data; analyses were limited to reporting absolute numbers and frequency distributions. Periodontal disease prevalence declined between 1990 (92.8%) to 2000 (87.2%) but a sharp rise was observed in the 2010 survey (94.0%). The proportion of participants demonstrating periodontal pockets of 6 mm and more increased in 2010 survey after showing improvements in 2000. Individuals not requiring periodontal treatment (TN0) increased in proportion from 1990 to 2000, only to drop in 2010. An increase in utilisation was observed alongside a growing uptake of periodontal procedures (62.2% in 2006 to 73.6% in 2010). Only about 10% of treatment was surgeries. While the clinical burden of periodontal disease is observed to be substantial, the types of treatment provided did not reflect the increasing needs for complex periodontal treatment. Emphasis on downstream and multi-collaborative efforts of oral health care is deemed fit to contain the burden of periodontal disease.

Health System Reform From The People’s Point Of View: Development Of Reliable And Valid Questionnaire

Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people’s perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire’s reliability were calculated by Cronbach’s alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett’s test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach’s alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people’s perspective.