Intravenous thrombolysis for multi-ethnic Asians with acute ischaemia stroke in Malaysian public primary stroke centres versus acute stroke ready hospitals: Comparison of real-world clinical outcomes

INTRODUCTION

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS). We aim to compare the realworld clinical outcomes and service efficiency of IVT in Malaysian primary stroke centres (PSCs) versus acute stroke ready hospitals (ASRHs).

MATERIALS AND METHODS

We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.

RESULTS

A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.

CONCLUSION

Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.

Job satisfaction of public and private primary care physicians in Malaysia: analysis of findings from QUALICO-PC

BACKGROUND

Job satisfaction of doctors is an important factor determining quality and performance of a health system. The aim of this study was to assess job satisfaction among doctors of the public and private primary care clinics in Malaysia and evaluate factors that could influence the job satisfaction rating.

METHODS

This study was part of the Quality and Costs of Primary Care (QUALICOPC) Malaysia, a cross-sectional survey conducted between August 2015 and June 2016 in Malaysia. Data was collected from doctors recruited from public and private primary care clinics using a standardised questionnaire. Comparisons were made between doctors working in public and private clinics, and logistic regression analysis was used to determine factors influencing the likelihood of job satisfaction outcomes.

RESULTS

A total of 221 doctors from the public and 239 doctors from the private sector completed the questionnaire. Compared to private doctors, a higher proportion of public doctors felt they were being overloaded with the administrative task (59.7% vs 36.0%) and part of the work does not make sense (33.9% vs 18.4%). Only 62.9% of public doctors felt that there was a good balance between effort and reward while a significantly higher proportion (85.8%) of private doctors reported the same. Over 80% of doctors in both sectors indicated continued interest in their job and agreed that being a doctor is a well-respected job. Logistic regression analysis showed public-private sector and practice location (urban-rural) to be significantly associated with work satisfaction outcomes.

CONCLUSION

A higher proportion of public doctors experienced pressure from administrative tasks and felt that part of their work does not make sense than their colleague in the private sector. At the same time, the majority of private doctors reported positive outcome on effort-and-reward balance compared to only one third of public doctors. The finding suggests that decreasing administrative workload and enhancing work-based supports might be the most effective ways to improve job satisfaction of primary care doctors because these are some of the main aspects of the job that doctors, especially in public clinics, are most unhappy with.

Poor bowel preparation in patients undergoing colonoscopy

A prospective analysis of 500 consecutive patients undergoing colonoscopy at the endoscopy unit of Hospital UKM under the care of the surgical unit was analysed. All colonoscopies were supervised by one of two consultant surgeons. The bowel preparation was graded from grade 1 to 4 according to established criteria. All patients had 3 litres of colonic lavage solution as bowel preparation. One hundred and two patients (20.4%) were considered to have poor bowel preparation, while 398 patients (79.6%) had good bowel preparation. Statistically significant factors that resulted in poor bowel preparation included age <20 years and >60 years (p<0.0001), and inpatients (p<0.0193). There was no significant difference in respect to sex, ethnic groups and the indication for colonoscopy. We conclude that young adults and the elderly as well as inpatients are more likely to have a poor bowel preparation using the standard regime.

The long term effectiveness of workshops in curriulum planning and design for teaching staff in Indonesian medical schools

A programme of basic curriculum change was concurrently introduced into ten Indonesian faculties of medicine which constitute an established system of medical schools with 260 separate academic departments. The programme was based on a 2-week workshop in curriculum planning and a series of follow-up activities. Within a 3-year period almost three quarters of the academic departments involved have defined a more selective curriculum based on sets of instructional (i.e. behavioural) objectives, and are involved in its implementation. This paper describes the methods used to bring about these developments and the attempts which were made to develop a structure within each medical school which would localize and ensure continuity of the changes set in motion. Because of the context from which conclusions have been drawn they have direct significance for large scale educational change in systems of medical schools in developing countries. The conclusions are however also applicable to changes in medical education in developed countries.