A Quality Improvement Approach to Reduce 30-day Readmissions and Mortality in Patients with Acute Decompensated Heart Failure.

OBJECTIVES: Heart failure [HF] hospital readmissions are a continued challenge in the care of HF patients, which contribute substantially to the high costs of the disease and high mortality rate in lower to middle income country. We implemented a quality improvement project to improve patient outcomes and resource utilization. METHODS: This study was a prospective cohort design with a historical comparison group. It was conducted to assess the difference in 30-day readmissions and mortality and to assess compliance rate with HF guideline between the historical pre-intervention audit 1 cohort and prospective post-intervention audit 2 cohorts. Audit 1 cohort were recruited from January to February 2019, whereas, audit 2 cohort which received the bundled intervention program were recruited from July to December 2019. Clinical outcomes were compared between cohorts using 30-day readmissions and mortality. RESULTS: A total of 50 and 164 patients were included in audit 1 and audit 2 cohort, respectively. Patients in the audit 2 cohort were younger [63.0 ± 14.5 in audit 1 vs 56.5 ± 12.7 in audit 2, p = 0.003] and majority were male [50.0% in audit 1 vs 72.0% in audit2, p = 0.004]. Thirty-day readmissions were significantly different [36.0% audit 1 vs. 22.0% audit 2, p = 0.045], but the mortality rates were similar [4.0%% audit 1 vs. 5.5% audit 2, p = 0.677] between two cohorts. CONCLUSION: A significant decrease in 30-day readmissions was observed in the post-intervention audit 2 cohort in our setting. Further study in larger population and prolong study follow-up is warranted.

Pre-marital sex and its predicting factors among Malaysian youths.

INTRODUCTION: This study aimed to examine the prevalence of pre-marital sex and its predicting factors among youth trainees undergoing a national skill training programme in the state of Malaysia. METHODS: Participants filled up health screening surveys at the beginning of their training period. A total of 1328 out of 1377 trainees were included in the study. Logistic regression was done to determine the potential predicting factors of pre-marital sex among the trainees. RESULTS: Most trainees were 18 years old (97.1%) and 56% were female and 44% were male. The prevalence of pre-marital sex among trainees of these youths was 4.6%. A total of 6.2% of the female trainees as compared to 2.6% of their male counterpart had had pre-marital sex. Analysis using multiple logistic regression revealed only six significant predictor variables which were religion, race, lover, reading or watching porn, masturbation and bullying. CONCLUSION: The prevalence of pre-marital sex amongst Malaysian youths is low as compared to those in developed countries. However, as pre-marital sex and pregnancy outside wedlock are largely socially unacceptable in Malaysia and may be kept hidden from others, the complications and social problems that may follow from this behaviour should be taken into consideration. Measures such as sex education and awareness programmes are needed among youth to curb this phenomenon from becoming a social as well as a public health concern.