Subject(s)
Brachial Plexus/drug effects , Forearm/surgery , Hand/surgery , Medical Audit/methods , Nerve Block/methods , Adrenergic Agonists/administration & dosage , Adrenergic Agonists/adverse effects , Amides/administration & dosage , Amides/adverse effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Epinephrine/administration & dosage , Epinephrine/adverse effects , Humans , Lidocaine/administration & dosage , Lidocaine/adverse effects , Monitoring, Physiologic/methods , Nerve Block/adverse effects , Patient Satisfaction , Prospective Studies , Ropivacaine , Treatment Outcome , United KingdomABSTRACT
The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting.
Subject(s)
Advance Directives , Attitude , Terminal Care , Aged , Aged, 80 and over , Female , Humans , Interviews as Topic , Malaysia , Male , Physician-Patient Relations , Qualitative Research , Quality of Life , Religion , Surveys and QuestionnairesABSTRACT
The in vivo and in vitro sensitivity of P. falciparum to quinine were studied simultaneously on 20 isolates of P. falciparum from infected patients in Rangoon and in Tharrawaddy Township. The in vivo study showed 85% sensitive and 5% resistance at RI level. The peak plasma quinine level in all the cases were above mean MIC on days 1, 3, 5 and 7. Schizont maturation was inhibited at 128 p.mol/well in 15% of the cases but the rest were at or below 64 p.mol/well in vitro test. However, no relationship was detected between the in vivo and in vitro sensitivity of quinine.