Journal of the Asian Medical Students Association
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A rare case of compression atelectasis due to spontaneous diaphragmatic hernia: a case report
Get PDFType IV diaphragmatic hernia is a rare case which has various clinical manifestations. The clinical manifestations as a result of protruded organ towards thoracic cavity in diaphragmatic hernia are varied from gastrointestinal symptoms such as epigastric pain, dysphagia and acid reflux. However, in a rare occasion, dyspnea may present as a result of compression atelectasis due to excessive increased in intrathoracic pressure. Here, we report a 57-year-old male patient who had spontaneous diaphragmatic hernia admitted with dyspnea as a chief complaint. This report might add another perspective to the physicians in facing the patient with atelectasis as the result of a high level of lung compression secondary to type IV diaphragmatic hernia
Surfing the Waves of Infodemics: Building a Cohesive Philippine Framework against Misinformation
Get PDFThe sudden exponential increase in information accompanying COVID-19 has presented significant barriers to effective health communication. In a country where 76 million active social media accounts originate, this infodemic due to the pandemic has exposed inadequacies in Philippine information systems. As such, this paper aims to present the infodemic in the Philippine context, analyze existing frameworks countering minsinformation, identify problems, and propose solutions for misinformation. A comprehensive review of existing policies was conducted by inputting keywords in known databases, and analyzing literature, laws, and social media policies in the Philippines. The analysis has showed that (1) the current uncentralized system presents difficulties in mobilizing experts; (2) the older demographic is a neglected population amid high risk for misinformation; (3) individual passivity in searching for legitimate sources puts people at higher risk; (4) current legal frameworks insufficiently characterize and delineate misinformation and disinformation, leading to concerns on implementation and human rights. To address this, evidence recommends (1) creating a centralized government institution, representative of various sectors, to serve as the source of understandable and reliable scientific information; (2) strengthening current legal frameworks, with an emphasis on education, due process, and human rights; (3) ingraining a culture of fact-checking within the Filipino psyche via stakeholder engagement. Clear roles and responsibilities, along with active stakeholder engagement, are needed to build individual resilience against misinformation and strengthen veritable institutions that aid the country in responding to future health crises
An Approach to the Flaws of the DRG System in Taiwan Regarding Trauma Care
Get PDFIntroduction
Accidents remain the sixth highest cause of death in Taiwan in the past nine years, and its resulting trauma is the major cause of death for citizens aged 12-44. Thanks to the National Health Insurance System (NHI) however, financial burdens of trauma care patients were eased.
In 2010, the NHI introduced a new payment mechanism, the Taiwan Diagnosis Related Groups (TW-DRGs) system. Phase 3 is expected to be carried out, with 654 new groups mainly trauma care related, significantly affecting patients’ rights to quality healthcare.
Method
We systematically reviewed journals and publications in electronic databases and organized the materials according to their highlighted relations between trauma care and the DRG.
Findings
The following four issues are identified:
The lack of specificity in diagnosis classification for complex trauma cases.
An outdated injury severity scoring system ISS.
Failure to tackle the poor patient referral system in Taiwan.
The lack of funds for the TW-DRGs and low coverage for multiple significant trauma cases.
Proposed solutions
To tackle these issues, the following policies are proposed:
Addressing the lack of specificity: Reclassify MDC groups with the help of DRG specialists.
ISS outdated: Replacing ISS with ICISS and detailed electronic documentation.
Systematic flaws: Adjusting the registration system and patient referral system.
Lack of funds: Adjusting premiums of the NHI, separating hospital fees and doctor fees, setting up independent application systems for the severely traumatized, and systemic reforms of the potentially biased censor mechanisms.
Conclusion
The current system has pros and cons, in between, we aim to seek balance between managing medical costs and safeguarding traumatized patients’ rights. By adopting a more detailed algorithm and organized system, we hope to create a fairer environment of trauma care that benefits both doctors and patients
Homelessness in the UK: How to Improve Accident and Emergency Discharge
Get PDFIntroduction (Aims & Problem Statement)
From 2010 to 2018, admissions of homeless patients into accident and emergency (A&E) services have trebled with readmission rates almost 2.5 times higher than housed patients.
Appropriate discharge of homeless patients is often inadequate with more than 70% of them being discharged back onto the street, without their housing or underlying health problems being addressed. With timely and effective healthcare, one in three homeless deaths can be avoided.
Our white paper aims to identify problems associated with current homeless hospital discharge (HHD) protocols in order to improve homeless discharge coordination.
Findings
Despite governmental interventions, including the Homeless Reduction Act 2017, which states that healthcare professionals should refer homeless patients to local authority, implementation is far from widespread.
Locally trialled quality improvement projects (QIPs) carried out throughout hospitals in the UK revealed that there was:
Poor medical staff awareness and compliance with the HHD protocol due to lack of understanding and excessive workload
Poor design of the HHD protocol which is not appropriate for A&E settings
A lack of pathways including non-UK citizens in HHD protocol
Proposed Solutions
We propose several solutions to tackle the stated problems:
Implement a dedicated homeless discharge team to address housing needs, community health service provisions and non-UK citizen support
Implement a simplified HHD protocol for A&E departments in the form of a checklist as a referral tool to a dedicated homeless discharge team
Include mandatory training to inform A&E staff on the use of HHD protocol and raise awareness around the issues homeless patients face
Conclusion
The introduction of a standardised HHD protocol and homeless discharge team will facilitate an effective discharge process for homeless patients, whilst mandatory training will improve staff compliance. Overall, through the implementation of our solutions we aim to improve homeless discharge, reduce readmissions, and improve trauma care for homeless patients
Healthcare Information Seeking Behaviour among the unaffected Indian population during COVID-19 pandemic and its impact on mental health: A cross sectional study
Get PDFIntroduction
COVID-19 information has played a vital role in anxiety and fear emerging during the pandemic.
Significance
This study explores the relation between COVID-19 awareness, anxiety, fear, precaution taking behaviour and recreational practices, identifying the role of healthcare communication in it.
Methods
This online survey based cross sectional study was conducted with the general Indian population excluding COVID-19 patients. A validated Google form assessing Generalised anxiety (GAD-7), COVID-19 awareness, fear & phobia, precaution taking behaviour and recreational practices was administered through snowball sampling.
Results
Among n = 834 participants, internet (90.89%) and social media (75.78%) were the dominant sources. 45.56% had anxiety (25.54% mild, 12.95% moderate, 7.07% severe) and 8.52% had phobia. Awareness among anxious and phobic participants was significantly more (Z = 7.156, 26.87 > 1.96, p < 0.05), while the precaution taking behaviour was significantly less among anxious (Z = 2.41 > 1.96, p < 0.05) and more among phobic participants (Z = 31.31 > 1.96, p <0.05). Number of sources, frequency, contact with confirmed cases, COVID-19 symptoms, employment and recreational practices correlated with awareness, anxiety, fear, and precautions to varying degrees.
Conclusion
Preferred information sources among Indians like other countries indicated that availability rather than reliability dictate usage of a source. Anxiety and phobia directly correlated with awareness while less anxiety and more phobia were associated with less precaution taking behaviour. Recreational practices (exercise, yoga & meditation) reduced anxiety and fear. Availability and accuracy of online healthcare information need to be regulated to overcome its effect on mental health
A Scoping Review on the Forms of Health Communication and Strategies that Promote Vaccine Confidence, Vaccine Trust, and Vaccine Uptake among Adults, Ages 20 to 59 years old, Living in High, Upper-middle, and Low-middle Income Countries
Get PDFIntroduction
Vaccination prevents 2-3 million deaths every year. This is made possible by the effective relay of information about its health benefits. However, 1.5 million people still die every year from vaccine-preventable diseases due to ineffective vaccine communication causing a decrease in vaccine confidence, trust, and consequently, uptake.
Significance
Various health communication strategies offer effective and practical vaccine campaigns in the Philippines for implementation and further promotion. This study aims to conduct a scoping review on existing literature to determine the forms of health communication that affect vaccine confidence, trust, and uptake among adults residing in high, upper-middle, and low-middle income countries.
Methods
PubMed, Cochrane, and HERDIN were utilized to identify papers of interest. After screening and assessment for eligibility, 29 studies were included in the final review using the PRISMA-ScR checklist and Arksey and O’Malley’s framework.
Results
Most of the studies recommended telecommunication, vaccine reminders, web-based education, written communication, and multi-interventional programs as communication strategies in cascading vaccine promotion in the healthcare system. Overall, face-to-face education was found to be the most widely accepted form of communication in increasing vaccine confidence, trust, and uptake.
Conclusion
Communication strategy for vaccine promotion is most effective to be perceived and comprehended by the target audience when presented audio-visually and technologically. Despite technology’s substantial help, face-to-face interaction is still essential when conveying a message to other people. Health communication is essential for vaccine promotion. Proper and consistent messaging lessens the anxiety, doubt, and confusion of the general public who will benefit the most from vaccines
Incidence study on the outcomes of hip fractures over a 5 year period in the UK.
Get PDFIntroduction
Hip fractures are a debilitating condition with increasing incidences in recent years in a growing ageing population. There are approximately 80,000 new cases annually in the UK. This major public health issue has an estimated annual cost of £1 billion, with many associated complications.
Objective
To analyse the incidences of different surgical options, length of stay, and mortality rates over 5 years.
Method
Data was extracted from the National Hip Fracture Database, looking at hip fractures in patients aged ≥60 years in the UK. This included the most popular surgical procedure performed for different fracture types, the average hospital length of stay, and the average annual mortality rate, between 2016 to 2020 inclusive. Statistical analysis was performed with single factor ANOVAs and Tukey’s post-hoc testing.
Results
Over the 5 year period, the percentage of patients with an intracapsular fracture receiving cemented arthroplasty increased from 85.46% to 92.32%. The percentage of extracapsular fractures managed with sliding hip screws dropped from 78.38% to 69.17%. For patients with subtrochanteric fractures, the percentage treated with an intramedullary nail increased from 82.24% to 90.15%. In 2016 the average hospital stay was 16.47 days (SD = 0.34), which went down to 13.73 days (SD = 1.50) in 2020. There was no clear change in the annual mortality rates, with a range of 6.50-7.50% over the 5 year period.
Conclusion
The current surgical management for hip fractures has great outcomes when using the most popular surgical procedures, of which shorter length of stays and lower mortality rates play a vital role. Whilst the recent COVID 19 pandemic has had a heavy impact on the UK, the trends over the past five years show clear improvements in hip fracture outcomes
CO2 Laser Ablation for the Manifestations of Multiple Cutaneous Neurofibromas in an Adult with Neurofibromatosis Type 1(NF1): A Case Report and Review of Literature
No full textIntroduction: Neurofibromatosis type 1 is a rare genetic disorder that is characterized by the growth of noncancerous neurocutaneous tumors that form near the spinal cord and along the peripheral nerves in the body. Symptoms NF-1 are usually detected in infancy or early childhood. However, in some cases, children and adults without family history may have a spontaneous genetic mutation of unknown cause. There are several modalities to treat NF-1, which include conventional surgery removal and CO2 laser ablation. The review of literature aims to compare the efficacy and outcomes of these two modalities.
Case presentation: A 32-year old post-partum Australian woman is presented to the neurosurgery department outpatient clinic. When she was around 20-year old, non-painful multiple noncancerous growth along her spine and peripheral nerves and multiple café-au-lait spots started to appear. The size and numbers of growth and spots are gradually increasing as she aged. The diagnosis of NF-1 was made according to the presence of four of the seven diagnostic criteria of the National Institute of Health Consensus Development Conference. Patient is scheduled to go to NF clinic 2 months after the meeting, in which the patient is planned to undergo a treatment of CO2 laser ablation.
Conclusions: Studies have shown that CO2 has outperformed conventional surgery in managing the clinical manifestation of NF-1 in term of effectivity and cosmetic outcomes.
Keywords: neurofibromatosis type I, von Recklinghausen’s disease, adult, post-partum woman, CO2 laser ablatio
Publishing, medical students and two pinches of inspiration: the recipe for success
Get PDFThe present submission is a letter to the editor. Hence, we did not include and abstract
A Case Report: Surgical Site Infection of Open Fracture Grade IIIC Caused by Methicillin-Resistant Staphylococcus aureus (MRSA)
Get PDFIntroduction: Based on World Health Organization (WHO) data in 2016, Surgical Site Infections (SSIs) occur in 11% of patients undergoing the procedure operations in developing countries. Overall, Staphylococcus aureus was the commonest bacteria isolated of the cultures in the postoperative period. Now, its considered endemic to most hospitals as Hospital Associated MRSA. Case History and Examination: A 60-year-old male presented to Rumah Sakit Daerah (RSD) dr. Soebandi Jember with a severe open fracture of his right lower extremity (cruris dextra) after hit by a truck. Patient came with massive bleeding because the rupture of tibial and femoral arteries. He had already given initial prophylactic antibiotic treatment such as cefazolin and amoxicillin before the operative procedure. After more than 3 months, he suffered a pyogenic infection with a biofilm plaque formation on his surgical sites. Microbiology Examination and Diagnosis: This Staphylococcus aureus resisted to 12 of 18 antibiotics that was tested including beta-lactams and macrolides groups of antibiotics. Treatment and Course: This case has already reported to the hospital and the patient was given topical Gentamicin and oral Clindamycin. Discussion: The initial mistreatment of fracture really becomes the risk factor of surgical site infection, and also this patient’s condition included significant risk factors for SSI because of his age, location of injury cleanliness, and high-energy injury. Conclusion and Recommendations: This case report of SSI in a postoperative of severe open fracture can be used to evaluate the empirical treatment that is used in RSD dr. Soebandi Jember