Treat all patients equally
Letter to the Editor
Darryl S. C. Goon
President, Medico-Legal Society of Malaysia
The Sun ePaper
http://www.sun2surf.com/article.cfm?id=53426
The Medico-Legal Society of Malaysia views with grave concern the report by the auditor-general of shoddy repairs and upgrading work in government clinics. Some of the shortcomings render the facilities unsafe for patients. There are others that are potential health hazards.
It is time for the government to extend the provisions of the Private Healthcare Facilities & Services Act 1998 (ACT 586) to government clinics and hospitals. This legislation sets out what are essentially the minimum acceptable standards to be expected from private healthcare facilities. The provisions are comprehensive.
Why are these minimum standards not required of government hospitals and medical clinics? One cannot countenance double standards in healthcare. It is urged that the government acknowledges that all patients, including those in government hospitals and medical and dental clinics, should be entitled to the benefits of the minimum standards imposed under the Act. While there may be practical problems these should not be allowed to impede an acceptance of the fact that minimum standards for medical and dental care must apply to all patients, whether in government hospitals or private hospitals, without discrimination.
The minimum standards may be brought into effect progressively. The first step is for the government to recognise that all patients are to be treated equally.
Friday, October 29, 2010
Sleep Disorders........
Sleep disorders in hemodialysis patients
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Tuesday, October 26, 2010
Kidney patients overcharged by RM140k .....
Free Malaysia Today
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
Friday, October 22, 2010
Proposed Standards for Hemodialysis Practices - What it means to you?
We are very concerned with the response or should we say "lack of response and participation" from the management of private and NGO dialysis centres and also organizations representing patients during the recently concluded 8th NKF Annual Dialysis Meeting 2010 at Berjaya Times Square Hotel, Kuala Lumpur.
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
Thursday, October 14, 2010
Determining Optimum Hemoglobin Sampling.....
Determining Optimum Hemoglobin Sampling for Anemia Management
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
Wednesday, October 13, 2010
Congratulations
Datuk Dr. Ghazali Bin Ahmad
Senior Consultant Nephrologist & Head of Nephrology Department,
Hospital Kuala Lumpur
on being confered the
PANGLIMA JASA NEGARA (P.J.N.)
By
Yang Di-Pertuan Agung Malaysia XIII
Seri Paduka Baginda Yang Di-Pertuan Agong
Al-Wathiqu Billah Tuanku Mizam Zainal Abidin Ibni Al-Marhum
Sultan Mahmud Al-Muktafi Billah Shah
on the occasion of His Royal Highness' Birthday
on 5th June 2010 / 22 Jamadilakhir 1431H
Best Wishes and Warmest Regards
MalaysianKidneySPA
Saturday, October 9, 2010
Reader's comments....
We have received with thanks a comment each from a reader, Mr Yudi on the following articles which appeared on this blog, kindly checkout his comments by clicking the articles below:
2. New Drug Clears Hemodialysis Catheter Clots September 17, 2010
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