Introduction : The utility of CXRs in ICU setting in Malaysia is variable with some centres practicing daily CXR strategy where as others practice on-demand strategy. The aim of this study was to compare both daily and on-demand CXR strategy and determine if the current practice of on-demand CXR can be safely continued without affecting the relevant clinical outcomes. Materials and method : This is a prospective cohort study of mechanically ventilated adult patients admitted to the intensive care units in HSB. The study period was from 1st April 2018 to 30th September 2018. Result : One hundred and sixty patients were recruited in both daily and on-demand CXR group respectively. There were no statistically significant difference in the duration of mechanical ventilation, ICU length of stay and mortality of the patients admitted to ICU in both groups (p=0.895). The mean percentage of CXR with new findings were significantly higher in the on-demand CXR group 83.5 compared to the daily CXR group which had only 38.8 (p<0.001). The mean percentage of CXR with new findings that prompted interventions was significantly higher in the on-demand CXR group compared to the daily CXR group, with a value of 83.9 and 34.9 respectively (p<0.001). Conclusion : In view of the low diagnostic and therapeutic yield of routine daily CXRs, we conclude that routine daily CXR practice can be safely abandoned in mechanically ventilated ICU patients. Keywords: Chest xray practice, Daily, On-demand, ICU

Leadership by healthcare professionals is essential in healthcare settings as it improves clinical outcomes in patients and cost-efficient care. This study aims to develop and determine validity and reliability of the Knowledge, Attitude and Practise questionnaire that evaluate leadership among medical doctors in Malaysia (KAP-LM). The KAP-LM was developed with 16 knowledge, 14 attitude and 14 practise items on medical leadership. The instrument then was tested for content and face validity followed by construct validity and internal consistency reliability. The questionnaire was completed by 180 medical officers from Hospital Selayang, Selangor and International Islamic University Malaysia Medical Centre, Pahang. Content validity and face validity of the KAP-LM were determined by six experts and 15 medical doctors respectively. Two factors were identified through factor analysis in construct validity. All the item in KAP-LM is reliable based on its internal consistency reliability with overall α=0.792. Inter correlation between dimensions of attitude and practise section in KAP-LM presented with good r-values ranging from 0.308 ~ 0.698. Evidence of validity and reliability of the KAP-LM (12 knowledge, 12 attitude, 12 practise items) have been obtained. The KAP-LM instrument can be used to assess KAP of leadership among medical doctors in Malaysia.

Postanaesthetic shivering is one of the common complications affecting patients who undergo surgical procedure in operation theatre. Shivering can occur in patients who received either general or neuroaxial anaesthesia. Although it is not a major complication, it gives negative consequences to patient, might delay in wound healing and cause interruption in vital signs monitoring perioperatively. We conducted this study to determine the prevalence and to find the potential risk factors that might contribute to the occurrence of postanaesthetic shivering in our operation theatre. Patients who were planned for surgery, either elective or emergency that fulfilled the inclusion criteria were recruited in this study involving 143 patients. Demographic characteristics, details of surgery and anaesthesia and occurrence of postanaesthetic shivering were documented and analyzed. The prevalence of postanaesthetic shivering in our operation theatre was 18.9%. Chi-square Test analysis of demographic characteristic showed race contributed to the postanaesthetic shivering with p value of 0.038. By using Multiple Logistic Regression Analysis, Malay has 6.71 times odds of postanaesthetic shivering as compared to other ethnic group. Increased anaesthesia duration and intraoperative lowest core body temperature (˚C) was shown to increase the odds of postanaesthetic shivering by 1.007 and 0.441 times prospectively. Subjects with comorbidities had 3.689 times odds of postanaesthetic shivering as compared to those without. Subjects with Diabetes Mellitus and who received Morphine had 0.189 and 0.158 times odds of postanaesthetic shivering as compared to those who do not. Based on Multivariate Analysis of Variance, using the Wilk’s Lambda test and an alpha level of 0.05, this test is significant (Wilk’s = 0.95, F (2,142) =3.683, p = 0.028 < 0.05). This study concluded that intraoperative lowest core body temperature and postoperative core body temperature were associated with occurrence of postanaesthetic shivering. The prevalence of postanaesthetic shivering in our centre is considered low as compared to previous study conducted in Malaysia. Several factors were identified to cause postanaesthteic shivering which are ethnicity, duration of anaesthesia, intraoperative lowest core body temperature, patients with multiple comorbidities and patients who received Morphine as intraoperative analgesia.

Introduction: Family satisfaction has been identified as a quality indicator in critical care area. It reflects the capabilities of health care professionals to meet the expectations and needs of the family members. The impact of family satisfaction level was also found to be associated with symptoms of psychological distress such as anxiety, depression and stress among family members. We evaluated the satisfaction level and prevalence, risk factor and correlation of psychological distress symptoms with the satisfaction level among family members in two Intensive Care Unit (ICU) in Malaysia. Methods: This is a cross-sectional, multicentre survey conducted in ICU at Hospital Sultanah Aminah Johor Bahru and International Islamic University Medical Centre. Inclusion criteria were family members aged more than 18 years old whose relatives were admitted in ICU for more than 3 days. They were enrolled 3 days after ICU admission and need to complete a modified version of Critical Care Family Needs Inventory (CCFNI) and the Depression, Anxiety and Stress Scales (DASS) questionnaires. Results: A total of 176 family members were enrolled in this study. The result of the study highlighted that 116 (66%) of the family members scores ≥ 3 denoting satisfaction with the mean CCFNI score was 3.11 (SD=0.3). Prevalence of depression, anxiety and stress were of 30.1%, 41.4% and 28.9% respectively. Risk factor for psychological distress symptoms were five family members related (female sex, spousal relationship, lower education, median income less than RM 4000 and staying with patient) and one patient related (age). Negative correlation between depression, anxiety and stress with CCFNI score were found (p < 0.05) but with low correlation coefficient (r=-0.178 to -0.209). Family members without symptoms of psychological distress were more satisfied (higher CCFNI score) with ICU care compared to those with symptoms of psychological distress (p < 0.05). Conclusions: Family members of ICU patient were satisfied with the care provided in the ICU. High rates of psychological distress symptoms in this study and its correlation with the satisfaction level highlight the need to identify and implement preventive and management strategies for family members to improve the overall ICU care.