Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 1, Issue 1, December 2012

  • Author: Ibrahiem Saeed Abdul-Rahman

    Abstract: Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. Complete, accurate, and timely discharge summaries can communicate important information back to the outpatient (OPD) physician, prevent adverse events and reduce readmission to hospital. However, discharge summaries are not always given the priority it deserves. Too often, discharge summaries contain insufficient or unnecessary information and fail to reach the OPD physician in time for the patient’s follow-up visit. We evaluated dis-charge summaries produced by first-year medical residents (R1) for their completeness and accuracy. Consecutive dis-charge summaries prepared by R1 residents for patients discharged from internal medicine wards were retrospectively eva-luated by two independent reviewers for presence and accuracy of essential items described by the Joint Commission for Hospital Accreditation. One-hundred and thirty-two discharge summaries were assessed for completeness and accuracy. Most items were incompletely reported with a given item missing in 2.3% - 91.7% of all discharge summaries. Inaccuracies of discharge summaries when compared to the patient chart as a reference standard ranged from 8.5% for final diagnosis to 50.9% for anticipated problems and suggested interventions with a mean of 29.6 + 13.3%.Only 18.2% of the discharge summaries were written within 48 hours of patient discharge (p < 0.001). The availability of a finalized (typed and signed) discharge summary at the first post-discharge visit was low (12.1%) and remained poor at 4 weeks (50.8%). Conclusion: Discharge summaries prepared by R1 physicians are grossly inadequate at documenting most of the essential domains described by the Joint Commission for Hospital Accreditation. Our findings will aid in the development of educational interventions for residents.

    Received: Nov. 26, 2012 Accepted: Published: Dec. 30, 2012

    DOI: 10.11648/j.cmr.20120101.11 View: Downloads:

  • Authors: Seyed Ali Asghar Mosavi, Ch’ng Tun Wang, Azhany Yaakub, Nik Azlan Zaid, Liza-Sharmini Ahmad Tajudin

    Abstract: Introduction: Fixed combination of topical pressure lowering drugs such as latanoprost and timolol (FCLT) has been reported to improve adherence and persistence to medication for chronic disease such as glaucoma. However, its effectiveness has been reported to be less compared to unfixed combination of latanoprost and timolol (UFCLT). Objective: To compare the efficacy of FCLT and UFCLT in Malaysian population. Methods: A non randomized prospective cohort study was conducted from January 2006 to December 2010 involving primary open-angle glaucoma (POAG), ocular hypertension (OHT) and normal-tension glaucoma (NTG) patients who failed to achieve target pressure or demonstrated progression of the disease while on monotherapy treatment with topical timolol XE 0.5% in eye clinic of Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. A total of 120 glaucoma patients were recruited with 58 were prescribed FCLT and 62 were treated with UFCLT. UFCLT is combination of topical timolol XE 0.5% and latanoprost 0.005%. Intraocular pressure (IOP) was taken at baseline and 3, 6, 9, 12 months post treatment. Results: A total of 95 patients completed the 12 months follow up (47 in FCLT group and 48 in UFCLT). Mean age was 61.0 SD 14.5 years old. Majority of cases were POAG (79%), followed by NTG (12%) and OHT (9%). Mean baseline IOP was 23.9 SD 5.9 mmHg and 19.9 SD 5.6 mmHg in UFCLT and FCLT groups respectively. Mean IOP reduction between baseline and final measurement in UFCLT and FCLT groups were -8.1 mmHg vs.-3.6 mmHg respectively (p<0.001). Based on repeated measures analysis of variance (RM ANOVA) and repeated measures analysis of covariance (RM ANCOVA) model, there was significant difference between UFCLT and FCLT (p =0.002). Conclusions: Both UFCLT and FCLT provide pressure lowering effect in Malaysian population. UFCLT provides significant better pressure lowering effect than FCLT. FCLT provides less inter-visit pressure fluctuation.

    Received: Dec. 15, 2012 Accepted: Published: Dec. 30, 2012

    DOI: 10.11648/j.cmr.20120101.12 View: Downloads:

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