Smart Home-based IoT for Real-time and Secure Remote Health Monitoring of Triage and Priority System using Body Sensors: Multi-driven Systematic Review.

The Internet of Things (IoT) has been identified in various applications across different domains, such as in the healthcare sector. IoT has also been recognised for its revolution in reshaping modern healthcare with aspiring wide range prospects, including economical, technological and social. This study aims to establish IoT-based smart home security solutions for real-time health monitoring technologies in telemedicine architecture. A multilayer taxonomy is driven and conducted in this study. In the first layer, a comprehensive analysis on telemedicine, which focuses on the client and server sides, shows that other studies associated with IoT-based smart home applications have several limitations that remain unaddressed. Particularly, remote patient monitoring in healthcare applications presents various facilities and benefits by adopting IoT-based smart home technologies without compromising the security requirements and potentially large number of risks. An extensive search is conducted to identify articles that handle these issues, related applications are comprehensively reviewed and a coherent taxonomy for these articles is established. A total number of (n = 3064) are gathered between 2007 and 2017 for most reliable databases, such as ScienceDirect, Web of Science and Institute of Electrical and Electronic Engineer Xplore databases. Then, the articles based on IoT studies that are associated with telemedicine applications are filtered. Nine articles are selected and classified into two categories. The first category, which accounts for 22.22% (n = 2/9), includes surveys on telemedicine articles and their applications. The second category, which accounts for 77.78% (n = 7/9), includes articles on the client and server sides of telemedicine architecture. The collected studies reveal the essential requirement in constructing another taxonomy layer and review IoT-based smart home security studies. Therefore, IoT-based smart home security features are introduced and analysed in the second layer. The security of smart home design based on IoT applications is an aspect that represents a crucial matter for general occupants of smart homes, in which studies are required to provide a better solution with patient security, privacy protection and security of users' entities from being stolen or compromised. Innovative technologies have dispersed limitations related to this matter. The existing gaps and trends in this area should be investigated to provide valuable visions for technical environments and researchers. Thus, 67 articles are obtained in the second layer of our taxonomy and are classified into six categories. In the first category, 25.37% (n = 17/67) of the articles focus on architecture design. In the second category, 17.91% (n = 12/67) includes security analysis articles that investigate the research status in the security area of IoT-based smart home applications. In the third category, 10.44% (n = 7/67) includes articles about security schemes. In the fourth category, 17.91% (n = 12/67) comprises security examination. In the fifth category, 13.43% (n = 9/67) analyses security protocols. In the final category, 14.92% (n = 10/67) analyses the security framework. Then, the identified basic characteristics of this emerging field are presented and provided in the following aspects. Open challenges experienced on the development of IoT-based smart home security are addressed to be adopted fully in telemedicine applications. Then, the requirements are provided to increase researcher's interest in this study area. On this basis, a number of recommendations for different parties are described to provide insights on the next steps that should be considered to enhance the security of smart homes based on IoT. A map matching for both taxonomies is developed in this study to determine the novel risks and benefits of IoT-based smart home security for real-time remote health monitoring within client and server sides in telemedicine applications.

Factors influencing physical inactivity among adults in Negeri Sembilan, Peninsular Malaysia.

BACKGROUND: Physical inactivity remains the most important modifiable risk factor in preventing a variety of noncommunicable diseases (NCDs) and has been identified to be a risk factor for obesity, heart disease and cancers. This study examined the prevalence and factors associated with physical inactivity among the suburban adult population in Port Dickson district, Negeri Sembilan, Peninsular Malaysia. MATERIAL AND METHODS: This was a community based crosssectional study involving 397 adult respondents conducted in February 2016. Data was collected by face-to-face interview using a structured questionnaire. Data regarding socio-demographic factors (age, gender, ethnicity, education level, marital status and monthly income, working hours), current behavioural stage of physical activity and perceived benefits and barriers to physical activity were collected. Physical activity measured using the International Physical Activity Questionnaire (IPAQ) with the cut-off point of less than 600 met-min per week was considered to be physically inactive. RESULTS: The prevalence of physical inactivity among adult population was 36.3%. Factors significantly associated with physical inactivity included age, gender, marital status, working hours and current behavioural stage of physical activity. CONCLUSION: Physical inactivity is high among the adult community in Negeri Sembilan district, Peninsular Malaysia and was strongly associated with age, gender, marital status, working hours and current behavioural stage of physical activity. It is important to identify individuals with physical inactivity and its associated factors early as this could severely affect the quality of life of the individuals.

Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy.

INTRODUCTION: Apical Hypertrophic Cardiomyopathy (Apical HCM) is an uncommon variant of hypertrophic cardiomyopathy, but it is relatively more common in Asian countries. This is a retrospective, non-randomised, single centre study of patients with Apical HCM focusing on their diastolic dysfunction grading, echocardiographic parameters and electrocardiograms (ECG). METHODS: All Apical HCM patients coming for clinic visits at the Institut Jantung Negara from September 2017 to September 2018 were included. We assessed their echocardiography images, grade their diastolic function and reviewed their ECG on presentation. RESULTS: Fifty patient were included, 82% (n=41) were males and 18% (n=9) females. The diastolic function grading of 37 (74%) patients were able to be determined using the updated 2016 American Society of Echocardiography (ASE) diastolic guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and 12% (n=6) had apical pouch. All patients had T inversion in the anterior leads of their ECG, and only 52% (n=26) fulfilled the ECG left ventricular hypertrophy (LVH) criteria. Majority of our patients presented with symptoms of chest pain (52%, n=26) and dyspnoea (42%, n=21). CONCLUSION: The updated 2016 ASE guideline makes it easier to evaluate LV diastolic function in most patients with Apical HCM. It also helps in elucidating the aetiology of dyspnoea, based on left atrial pressure. Clinicians should have a high index of suspicion for Apical HCM when faced with deep T inversion on ECG, in addition to a thick LV apex with an aceof- spades appearance during diastole.

Index of suspicion with appropriate timing of CT scan helps prevent missed diagnosis in urologic trauma.

Ureteric and bladder injuries are uncommon, difficult to diagnose and rarely occur in isolation. Diagnosis is often delayed or missed at presentation. Therefore, high clinical suspicion and appropriate timing of computed tomography (CT) are of paramount importance. We report two cases (ureteropelvic junction avulsion and ruptured dome of bladder) whereby the presentations were subtle and would have been missed if not for high clinical suspicion. This article discusses the problems associated with these urologic injuries, as well as how to develop a high index of suspicion based on the pattern of anatomical disruption, mechanism of injury, physiological abnormality and comorbidity.

Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis.

OBJECTIVE: Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject. METHODS: We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value. RESULTS: In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern. CONCLUSION: Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.

Long-term future risk of severe exacerbations: Distinct 5-year trajectories of problematic asthma.

BACKGROUND: Assessing future risk of exacerbations is an important component of asthma management. Existing studies have investigated short- but not long-term risk. Problematic asthma patients with unfavorable long-term disease trajectory and persistently frequent severe exacerbations need to be identified early to guide treatment. AIM: To identify distinct trajectories of severe exacerbation rates among "problematic asthma" patients and develop a risk score to predict the most unfavorable trajectory. METHODS: Severe exacerbation rates over five years for 177 "problematic asthma" patients presenting to a specialist asthma clinic were tracked. Distinct trajectories of severe exacerbation rates were identified using group-based trajectory modeling. Baseline predictors of trajectory were identified and used to develop a clinical risk score for predicting the most unfavorable trajectory. RESULTS: Three distinct trajectories were found: 58.5% had rare intermittent severe exacerbations ("infrequent"), 32.0% had frequent severe exacerbations at baseline but improved subsequently ("nonpersistently frequent"), and 9.5% exhibited persistently frequent severe exacerbations, with the highest incidence of near-fatal asthma ("persistently frequent"). A clinical risk score composed of ≥2 severe exacerbations in the past year (+2 points), history of near-fatal asthma (+1 point), body mass index ≥25kg/m2 (+1 point), obstructive sleep apnea (+1 point), gastroesophageal reflux (+1 point), and depression (+1 point) was predictive of the "persistently frequent" trajectory (area under the receiver operating characteristic curve: 0.84, sensitivity 72.2%, specificity 81.1% using cutoff ≥3 points). The trajectories and clinical risk score had excellent performance in an independent validation cohort. CONCLUSIONS: Patients with problematic asthma follow distinct illness trajectories over a period of five years. We have derived and validated a clinical risk score that accurately identifies patients who will have persistently frequent severe exacerbations in the future.

Total percutaneous endovascular aneurysm repair (pEVAR): the initial experience in Hospital Kuala Lumpur.

INTRODUCTION: There has been a paradigm shift in the treatment of AAA with the advent of endovascular aneurysm repair (EVAR). Rapid progress and evolution of endovascular technology has brought forth smaller profile devices and closure devices. Total percutaneous endovascular aneurysm repair (pEVAR) involves the usage of suture-mediated closure devices (SMCDs) at vascular access sites to avoid a traditional surgical cutdown. MATERIALS AND METHODS: We retrospectively reviewed our experience of pEVAR between April 2013 and July 2014. Primary success of the procedure was defined as closure of a common femoral artery (CFA) arteriotomy without the need for any secondary surgical or endovascular procedure within 30 days. RESULTS: In total there were 10 pEVAR cases performed in the study period, one case in Queen Elizabeth Hospital during visiting vascular service. Patients have a mean age of 73.4 year old (66-77 year old) The mean abdominal aortic size was 7.2 cm (5.6-10.0cm). Mean femoral artery diameter was 9.0 mm on the right and 8.9 mm on the left. Mean duration of surgery was 119 minutes (98- 153 minutes). 50% of patients were discharged at post-operative day one, 30%- day two and 20%- day three. Primary success was achieved in 9 patients (90%) or in 19 CFA closures (95%). No major complication was reported. DISCUSSION: We believe that with proper selection of patients undergoing EVAR, pEVAR offers a better option of vascular access with shorter operative time, less post- operative pain, shorter hospital stay and minimises the potential complications of a conventional femoral cutdown.

Serotonin availability in rat colon is reduced during a Western diet model of obesity.

Constipation and slowed transit are associated with diet-induced obesity, although the mechanisms by which this occurs are unclear. Enterochromaffin (EC) cells within the intestinal epithelium respond to mechanical stimulation with the release of serotonin [5-hydroxytryptamine (5-HT)], which promotes transit. Thus our aim was to characterize 5-HT availability in the rat colon of a physiologically relevant model of diet-induced obesity. EC cell numbers were determined immunohistochemically in chow-fed (CF) and Western diet-fed (WD) rats, while electrochemical methods were used to measure mechanically evoked (peak) and steady-state (SS) 5-HT levels. Fluoxetine was used to block the 5-HT reuptake transporter (SERT), and the levels of mRNA for tryptophan hydroxylase 1 and SERT were determined by quantitative PCR, and SERT protein was determined by Western blot. In WD rats, there was a significant decrease in the total number of EC cells per crypt (0.86 ± 0.06 and 0.71 ± 0.05 in CF and WD, respectively), which was supported by a reduction in the levels of 5-HT in WD rats (2.9 ± 1.0 and 10.5 ± 2.6 µM at SS and peak, respectively) compared with CF rats (7.3 ± 0.4 and 18.4 ± 3.4 µM at SS and peak, respectively). SERT-dependent uptake of 5-HT was unchanged, which was supported by a lack of change in SERT protein levels. In WD rats, there was no change in tryptophan hydroxylase 1 mRNA but an increase in SERT mRNA. In conclusion, our data show that foods typical of a WD are associated with decreased 5-HT availability in rat colon. Decreased 5-HT availability is driven primarily by a reduction in the numbers and/or 5-HT content of EC cells, which are likely to be associated with decreased intestinal motility in vivo.

Developing high intensity ultrasonic cleaning (HIUC) for post-processing additively manufactured metal components.

The high energy phenomenon of cavitation bubble collapses has enabled numerous applications, including cleaning. In ultrasonic cleaning, cavitation intensity is typically lower than in other applications, such as sonochemistry and material processing. However, there has been an emerging application in intense cleaning of metal additively manufactured (AM) components. The presence of partially melted powders on AM surfaces is undesirable, contributing to high surface roughness and posing contamination risks during usage. We designed a high-intensity cavitation cleaning process that has significantly higher inertial cavitation intensity - i.e., erosion potential - than a conventional ultrasonic cleaning tank. Through acoustic signal characterisation, we showed that placing transducer sets on four sides of the tank could effectively focus and generate high-amplitude pressure waves directed towards the central region. Strong subharmonic signals indicate intensely inertial cavitation throughout the tank. Cavitation intensities were measured at various locations to understand the wave transmission characteristics and distribution patterns. Our results show that the cavitation intensity distribution is highly dependent on the height position. Finally, we demonstrated that the high intensity ultrasonic cleaning (HIUC) process could remove partially melted powders from an AM surface - which was not possible through conventional ultrasonic cleaning. HIUC could lead to higher cleaning efficiency and enhanced AM specimen cleanliness.

Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital?

AIMS: Although there is emerging evidence to suggest equivalent oncological outcomes using a watch and wait approach compared with primary total mesorectal excision surgery, there is a paucity of evidence about the safety and efficacy of this approach in routine clinical practice. Here we report the long-term outcomes and quality of life from patients managed with watch and wait following a clinical complete response (cCR) to neoadjuvant therapy. MATERIALS AND METHODS: Patients with adenocarcinoma of the rectum with cCR following neoadjuvant therapy managed using watch and wait were retrospectively identified. Demographic data, performance status, pretreatment staging information, oncological and surgical outcomes were obtained from routinely collected clinical data. Quality of life was measured by trained clinicians during telephone interviews. RESULTS: Over a 7-year period, 506 patients were treated for rectal cancer, 276 had neoadjuvant therapy and 72 had a cCR (26.1%). Sixty-three were managed with watch and wait. Thirteen patients had mucosal regrowth. There was no significant difference in the incidence of metastatic disease between the surgical and watch and wait cohorts (P = 0.38). The 13 patients with mucosal regrowth underwent salvage surgery. Eleven of the patients who underwent surgical resection had R0 resections. There was also a statistically and clinically significant improvement in the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) trial outcome index (P = 0.022). CONCLUSION: This study shows that watch and wait is safe and effective outside of tertiary referral centres. It suggests that an opportunistic cCR is durable and when mucosal regrowth occurs it can be salvaged. Finally, we have shown that quality of life is probably improved if a watch and wait approach is adopted.

Novel technique using amplatzer AVP I stent in management for giant renal artery pseudoaneurysm.

Renal artery pseudoaneurysm (RAP) is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We describe a case 66 year old patient who presented with a painful abdominal lumbar mass. CT scan show a giant renal artery pseudoaneurysm. We discuss management of giant renal artery pseudoaneurysm, both open surgery and endovascular surgery. Endovascular arterial embolization and stent techniques is feasible. However, open surgical treatment remains to be most effective and radical method in emergency setting.

Synthesis of quaternary carbon centers via hydroformylation.

The application of hydroformylation to the synthesis of quaternary carbon centers is reported. The synthesis of the highly substituted carbon is achieved by applying a catalytic amount of 1. Ligand 1 serves as a catalytic directing group by covalently and reversibly binding to both the substrate and catalyst. The intramolecular nature of the directing group strategy accelerates the hydroformylation reaction such that the reaction is performed at mild temperatures (35-55 degrees C) and with excellent regioselectivity (b:l > 94:6).

Registered nurses' medication management of the elderly in aged care facilities.

BACKGROUND: Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications. AIM: To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful. METHOD: This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained. FINDINGS: Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001). CONCLUSION AND IMPLICATIONS: Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.

Prevalence of onodi cells in hospital raja permaisuri bainun, ipoh, malaysia.

INTRODUCTION: Onodi cell is a posterior ethmoid air cell that pneumatizes into the sphenoid sinus, It is an important entity for clinicians when performing endoscopic sinus surgery (EES) because it encroaches into the optic nerve and internal carotid artery. CT-scans are the road map for ESS to prevent damage to structures mentioned above. Its prevalence in Malaysia is unknown. METHOD: 102 CT-scans of paranasal sinuses dated from 2006- 2009 in Hospital Raja Permaisuri Bainun (HRPB), Ipoh, Malaysia were studied by Consultant Rhinologist (HS). The Onodi Cells were recorded as present on the left side, right side or bilaterally. RESULTS: A total of 59 males and 43 females with a mean age of 42 were studied. Twenty of the scans were noted to have Onodi cells. Of those with Onodi present, 5 were females and 15 were males; 9 of them had sinusitis and 11 had nasal polyposis. None of them were noted to have complications related to the Onodi cells. There were 6 with left side involvement, 7 with right side involvement and 7 with bilateral Onodi cells. CONCLUSION: A prevalence of 19.6% was noted in the patients in HRPB, Ipoh, corresponding to other CT-scan studies ranging from 7-24%. The presence of Onodi cells should be routinely looked for by ESS surgeons to prevent damaging the optic nerve and internal carotid artery.

The prevalence and characteristics associated with mother-infant bed-sharing in Klang district, Malaysia.

This was a cross-sectional study to determine the prevalence and characteristics of mother-infant bed-sharing practice in Klang district, Malaysia. Data was collected by face-to-face interview using a structured questionnaire for a four month period in 2006. A total of 682 mother-infant pairs attending government health clinics were included in the study. Data regarding socio-demographic characteristics of the mothers, information on the infants, bed-sharing and breastfeeding practices were collected. The mean maternal age was 28.4 +/- 5.1 years while the mean infant gestational age was 38.8 +/- 1.8 weeks. The study showed the prevalence of bed-sharing was 73.5% (95% CI: 70.0, 76.7). In multivariate analysis; area of interview, maternal occupation, family income, breastfeeding and infant birth weight were associated with bed-sharing after adjusted for maternal ethnicity, age, marital status, educational level, parity, infant gender and infant gestational age. In conclusion, bed-sharing is a common practice in Klang district, Malaysia, not specific to ethnicity, but strongly associated with low family income and breastfeeding.

Bubble dynamics and cavitation intensity in milli-scale channels under an ultrasonic horn.

Under a vibrating ultrasonic horn device, intense cavitation occurs but is restricted to a small volume due to strong attenuation effects. In this study, milli-scale channels were introduced under the horn. The effect of this on the cavitation development and intensity within the channels were explored. High speed videography of up to 100,000 fps and acoustic signal acquisition through hydrophone were conducted. Cavitation intensity was observed to increase within the channels as compared to free field condition. Bubble density increased with a decrease in channel diameter and a rise in ultrasonic amplitude. Furthermore, an intriguing phenomenon of large bubble cluster formation near the channel exit (20 mm away from the horn surface) was detected. The oscillation behaviour of these clusters is dependent on both channel diameter and ultrasonic amplitude. At the maximum ultrasonic amplitude, the clusters reached maximum radiuses exceeding 3 mm and collapsed violently. Repetitive transient collapses near the exit region suggest that the introduction of milli-scale channels could extend the effective cavitation zone length and enhance the overall cavitation intensity under an ultrasonic horn.

Alpha-thalassaemia in association with beta-thalassaemia patients in Malaysia: a study on the co-inheritance of both disorders.

BACKGROUND/AIMS: Individuals with double heterozygosity for alpha- and beta-thalassaemia and heterozygous beta-thalassaemia show a similar haematological picture. Co-inheritance of alpha- and beta-thalassaemia in both partners may result in pregnancies with either Hb Bart's hydrops foetalis or beta-thalassaemia major, or pregnancies with both disorders. METHODS: The co-inheritance of alpha-thalassaemia in 322 beta-thalassaemia carriers in Malaysia was studied. RESULTS: The frequency of alpha-thalassaemia in the beta-thalassaemia carriers was 12.7% (41/322), with a carrier frequency of 7.8% for the SEA deletion, 3.7% for the -alpha(3.7) deletion, 0.9% for Hb Constant Spring and 0.3% for the -alpha(4.2) deletion. CONCLUSION: Double heterozygosity for alpha- and beta-thalassaemia was confirmed in 5 out of the 41 couples and the risk of the fatal condition Hb Bart's hydrops foetalis was confirmed in two of these couples. Detection of the Southeast Asian (SEA) deletion in the Malaysian Malays in this study confirms that Hb Bart's hydrops foetalis can occur in this ethnic group. Results of this study have provided new information on the frequency and different types of alpha-thalassaemia (--(SEA), -alpha(3.7) and -alpha(4.2) deletions, Hb Constant Spring) in Malaysian beta-thalassaemia carriers.

Orthopaedic patients' experience of motor vehicle accident in Singapore.

AIM: The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital. BACKGROUND: Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients. METHOD: A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and 'snowballing'. Interviews were audiotaped and transcribed verbatim in preparation for analysis. FINDINGS: The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation. CONCLUSION: The study provided an understanding of orthopaedic patients' experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims' experiences of MVAs and nurses caring for MVA victims.

Reassessment on the development of children with disability in Malaysia.

This is a cohort study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to determine whether reassessment on the development of children with disability under rehabilitation should be done at three months interval or six months interval. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study was carried out for seven months from 1st August 2004 until 28th February 2005. A total of 168 disabled children followed up for six months were selected in this study. Schedule of Growing Scale (SGS) II was the tool used for analysis. Results showed a statistically significant difference in the mean total SGS score at six months interval but not at three months interval. The result suggests that reassessment on children with Down Syndrome, Autism, Cerebral Palsy, mental retardation and delayed speech under rehabilitation should be carried out every six months while children with gross developmental delay and slow learner might need a longer interval for reassessment.

Assessing the development of children with disability in Malaysia.

This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.