Serdang Hospital

Hospital accreditation is globally recognized as a strategic framework for standardizing healthcare quality. However, the long-term efficacy of accreditation in sustaining Infection Prevention and Control (IPC) practices and reducing Healthcare-Associated Infections (HAIs) remains fiercely debated. Most existing literature relies on cross-sectional data, failing to capture the temporal stability of post-accreditation outcomes. A systematic review and meta-analysis were conducted following PRISMA guidelines. We analyzed longitudinal, interrupted time-series, and pre-and-post research articles evaluating IPC compliance and HAI incidence before, during, and after accreditation cycles. Data extraction focused on sample sizes, means, and standard deviations to calculate the Standardized Mean Difference (SMD) using a DerSimonian-Laird random-effects model. Heterogeneity was assessed via the I-squared statistic. Eight longitudinal studies encompassing varying international healthcare contexts were included. The pooled meta-analysis demonstrated a statistically significant, moderate improvement in IPC outcomes post-accreditation, with an overall SMD of 0.52 (95 percent Confidence Interval: 0.38 to 0.66, p < 0.001). Subgroup analyses revealed that structural IPC compliance measures showed higher effect sizes (SMD = 0.58) compared to direct clinical outcomes like HAI incidence density reductions (SMD = 0.42). Moderate heterogeneity was observed (I-squared = 54 percent). In conclusion, hospital accreditation acts as a significant catalyst for improving IPC metrics over time. The moderate effect size on direct clinical outcomes suggests that accreditation provides a structural foundation that must be coupled with continuous quality improvement and strong institutional leadership to prevent post-survey decay.

BackgroundVenous thromboembolism (VTE) in childhood is an uncommon event compared with adults.The estimated incidence of pediatric PE is less than 1 per 100,000 annually [1].Most cases are provoked by identifiable factors including central venous catheters, oncological disease, or systemic infection [2].Reports of unprovoked pediatric PE are scarce in the literature, and their rarity makes recognition challenging.We present a case of unprovoked PE in a 12-year-old child, followed by a review of potential underlying mechanisms and implications for clinical care. Case PresentationA previously healthy 12-year-old child presented with acute onset pleuritic chest pain and dyspnoea.There was no history of recent infection, trauma, immobilisation, surgery, or use of central venous catheters.Past medical and family history were unremarkable, with no known thrombophilia.On examination, the patient was tachycardic with oxygen desaturation but haemodynamically stable.Chest radiograph was unremarkable.CT pulmonary angiography revealed filling defects within the segmental branches of the right pulmonary artery, consistent with acute pulmonary embolism.Laboratory investigations including complete blood count, renal and liver function were normal.A full thrombophilia screen was performed, including protein C, protein S, antithrombin levels, Factor V Leiden mutation, and prothrombin G20210A mutation, all of which were within normal limits.No underlying inflammatory or systemic disorder was identified.The patient was commenced on low-molecular-weight heparin and transitioned to a direct oral anticoagulant.Clinical symptoms improved, and follow-up imaging demonstrated resolution of the embolus.The patient continues on anticoagulation with close outpatient followup. DiscussionPulmonary embolism (PE) in childhood is rare, with an estimated annual incidence of 0.9 per 100,000 children [1].Most

Mother-to-child transmission (MTCT) is a primary source of hepatitis B virus (HBV) infection in endemic regions. The World Health Organization (WHO) aims to reduce HBV seroprevalence among children under five to less than 0.1% by 2030. In Malaysia, the seroprevalence of hepatitis B surface antigen (HBsAg) in children has declined to 0.4%, but additional measures are needed. A pilot study in Sarawak, Malaysia, screened 474 pregnant women for HBsAg. Those with high MTCT risk received tenofovir disoproxil fumarate from 28 weeks of gestation to 12 weeks postpartum. Infants received timely birth-dose HBV vaccine and hepatitis B immunoglobulin (HBIG) where indicated. Among screened women, 1.9% were HBsAg positive, with 55.6% newly diagnosed. No MTCT cases were observed. Risk factors included maternal age over 35 years old household exposure, and sexual transmission risk. These findings demonstrate the feasibility of WHO's PMTCT strategies in low-resource settings, supporting nationwide expansion in Malaysia.

Non-arteritic anterior ischaemic optic neuropathy (NAION) is an ischaemic disorder involving the anterior portion of the optic nerve. It typically presents with acute, painless vision loss upon awakening, accompanied by optic disc oedema and an inferior altitudinal visual field defect. We report a 44-year-old woman with multiple metabolic risk factors, obstructive sleep apnoea, and an anatomically crowded optic disc, who developed progressive NAION followed by sequential involvement of the fellow eye, despite optimization of her risk factors.

This article is devoted to the development and comprehensive analysis of the cascade model of formation of digital competencies (CC) of teachers, which is a systemic response to the challenges of global digital transformation and the national strategy of education development in the Republic of Kazakhstan. The model is conceptually structured into three interrelated stages: the first is a systematized process of formation of DSC, including motivational-target, methodological, content-technological and regulatory-result blocks; the second is the direct application of formed DSC in everyday pedagogical activities; and the third is the assessment of the impact of these competencies on the academic results of students. Special attention in the content-technological block is paid to the integration of augmented reality (AR) and generative artificial intelligence (GenAI) technologies, including details of specific pedagogical scenarios of their use. To confirm the relevance and demand for the model, the results of the first stage of a large-scale empirical survey covering 1352 teachers are presented. This survey has convincingly demonstrated the high interest of the teaching community in mastering interactive lesson formats and introducing AR and GenAI technologies.The paper compares the proposed model with relevant foreign frameworks, including DigCompEdu, which ensures its theoretical validity. Implications of the primary empirical results for further adaptation are discussed, and the plan for longitudinal validation of the "Application" and "Impact" stages is detailed.Thus, the article is a contribution to the development of theoretical and methodological foundations for the formation of teachers' CK and their practical realization in the conditions of digital educational environment.

IntroductionLate-onset Legg-Calvé-Perthes disease, which is diagnosed in children older than 8 years old, is considered to have a poorer outcome. The outcome depends on the severity of the disease, the age at presentation, and the method of treatment. This study aims to evaluate the effectiveness of containment using femoral varus osteotomy (FVO) in late-onset Legg-Calvé-Perthes disease patients.Material and methodsWe reviewed seven patients with Legg-Calvé-Perthes disease aged nine and older (four Herring B and three Herring C) who had containable hip included two cases of pseudo hinged abduction. All patients went through FVO at the subtrochanteric level, with the varus adjustment guided by an image intensifier to ensure hip containment in a neutral position, and the site was then fixed with a plate. The outcomes were assessed based on Stulberg classification of radiograph at skeletal maturity with a mean follow-up of 9.99 years.ResultsAll seven patients that went through FVO were between nine to eleven years old. Among the four Herring B patients, one had Stulberg I, one had Stulberg II, and two had Stulberg III. All three Herring C patients had Stulberg III.ConclusionFemoral varus osteotomy produces a reasonable outcome in patients of nine years and older, including those with pseudo-hinge abduction.

Pulmonary arterial hypertension (PAH) is a severe and potentially life-threatening manifestation of connective tissue diseases, often presenting insidiously and complicating timely diagnosis. We report the case of a 48-year-old Saudi woman with no prior chronic illness who presented with progressive exertional dyspnea and fatigue over six weeks. Examination revealed mild central cyanosis, elevated jugular venous pressure, and a prominent right ventricular heave. Laboratory evaluation showed elevated NT-proBNP and mild hypoxemia, while echocardiography demonstrated right ventricular dilation and an estimated pulmonary artery systolic pressure of 70 mmHg. Right heart catheterization confirmed pre-capillary pulmonary hypertension. Serologic workup revealed high-titer anti-U1 RNP antibodies, ANA positivity, and features consistent with mixed connective tissue disease (MCTD), with no evidence of left heart disease, thromboembolic disease, or significant interstitial lung involvement. Management included combination PAH-targeted therapy with an endothelin receptor antagonist and a phosphodiesterase-5 inhibitor, alongside low-dose corticosteroid immunosuppression. Supportive care comprised oxygen supplementation and close hemodynamic monitoring. Over three months, the patient’s functional status improved from WHO functional class III to II, with reduction in NT-proBNP and increased six-minute walk distance. This case underscores the diagnostic challenge of MCTD presenting primarily with PAH, emphasizing that subtle systemic features may precede cardiovascular compromise. Early recognition, prompt hemodynamic assessment, and a multidisciplinary management strategy are crucial to improve prognosis and prevent irreversible right ventricular dysfunction. Clinicians should maintain a high index of suspicion for PAH in patients with connective tissue disease, even in the absence of overt systemic manifestations.

Abstract Background: Research on ChatGPT-supported nursing care plan texts plays a critical role in making nursing education more innovative and accessible. These studies strengthen education by improving the readability, reliability, and quality of the texts. Purpose: This study aims to evaluate the readability, reliability, and quality of nursing care plan texts generated by ChatGPT. Methods: The study sample consisted of 50 texts generated by ChatGPT based on selected nursing diagnoses from NANDA 2021–2023. These texts were evaluated using a descriptive criteria form, the DISCERN tool, and readability indices including the Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index, and Flesch-Kincaid Grade Level (FKGL). Results: According to our findings, the readability level of the nursing care plans generated by ChatGPT was significantly higher than the recommended 6th-grade level (P < .001). The mean DISCERN score was 45.93 ± 4.72, indicating a moderate level of reliability for all evaluated texts. Additionally, 97.5% of the texts also achieved moderate scores on the information quality subscale. A positive and statistically significant correlation was found between the number of verifiable references and both the reliability (r = 0.408) and quality (r = 0.379) scores of the texts (P < .05). Conclusion: It should be noted that these AI-based chatbot tools cannot replace comprehensive patient care plans. In AI applications, it is recommended that the readability of generated content be improved, reliable references be included, and all outputs be reviewed by a professional team.

Interposition arthroplasty is a joint-preserving surgical technique that involves the placement of biological or synthetic tissue between articulating surfaces to restore function and alleviate pain. Although rarely used in modern practice, it remains a valuable option in selected cases, particularly in young, active patients with complex post-traumatic joint pathology. We report the case of a man in his 40s who presented with persistent anterior knee pain and functional impairment due to isolated post-traumatic patellofemoral arthritis and a significant trochlear bone defect following distal femur fracture fixation. Imaging revealed extensive trochlear cartilage loss, bony irregularities, and a contained central defect. We performed an interposition arthroplasty utilising an ipsilateral suprapatellar synovial flap, in conjunction with bone grafting of the osseous defect, trochleaplasty, patelloplasty, and lateral patellar facetectomy. Postoperatively, the patient experienced substantial pain relief and functional recovery, maintained at two-year follow-up. This case demonstrates that interposition arthroplasty, though seldom employed today, can offer excellent outcomes in carefully selected patients with isolated patellofemoral arthritis.

Introduction: Individuals with heart failure anticipate adjustment to self-care behaviors following hospital discharge. Self-care in heart failure includes medication adherence, dietary modifications, symptom monitoring, and activity adjustment. Adequate self-care behavior may contribute to enhanced outcomes, decreased hospitalization, and improved quality of life in patients with heart failure. This study aimed to determine the level of self-care behavior, quality of life, and its relationships among patients with heart failure. Methods: A cross-sectional study using purposive sampling was conducted among 200 heart failure patients at a teaching hospital in Selangor, Malaysia. The sample size was determined using G*Power to ensure adequate statistical power. Data were collected using the Self-Care of Heart Failure Index (SCHFI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Descriptive statistics, Pearson’s correlation, and multiple linear regression were used in this study. Results: The results indicated that the total mean score of self-care behavior was 145.42 and SD=16.23. Most patients demonstrated good quality of life (n=73, 36.5%), moderate quality of life (n=62, 31%), and poor quality of life (n=65, 32.5 %). Pearson's correlation revealed a significant (p<0.001) correlation (r = 0.651) between self-care behavior and quality of life. Conclusions: In conclusion, this study demonstrated that higher levels of self-care are associated with better quality of life in patients with heart failure. It is recommended that nurses provide individualized self-care education at discharge, focusing on medication adherence, symptom monitoring, and lifestyle changes to improve quality of life.