Farewell O & G

It is simply the best rotation!


// The obsolete protocol. Don't worry, we students always keep it updated - lots of criss-crossing here and there!


// Prof F-eeney, and the lady from Exam office, S-harla in nice Indian dress.

Favourite and memorable quotes:

A minute you spend on O & G is twice as worth you could on Paediatrics, Psychiatry or even Public Health!
Prof F-eeney on the very first day, mentioning about heavier wattage given to O&G

If you see a husband in labour room, usually it is their first baby.
Prof F-eeney during Obstetrics morning rounds

The thinnest book is the one to read, while the thick ones are for reference and best left on someone else's shelf, not yours.
Dr K-ieran (while showing his Impey) during revision classes

While I was examining this lady a little while ago, I managed to observe fetal movements. Now, the examiner definitely wouldn't disagree with you, would he?
Prof F-eeney's tutoring on how to present clinical findings.

Where is your other friend? H1N1? 
Dr S-omas on missing groupmate

You know, diet control is the way to go in managing diabetes in pregnancy.
Dr A-nil

I have nothing to disagree about your history. It's superb!
Dr K-ieran after case presentation. Well he always said that.

Hey I think you can be a politician. You completely DID NOT answer my question.
Dr J-erilee during evening tutorial

What!!! Pink branula? You think it is nice to match with the hospital gown ka? You. Go and take all the branulas in different colours. I'll show you what's the difference between green, blue, chocolate, grey and whatever colour you have.
Dr A-nil during Obstetrics morning rounds

A picture worth a thousand words. Now where's my whiteboard marker?
Dr M-aha before beginning her lecture

In infertility case, the most worried party would be the mother-in-law, not the mother.
Dr A-zmy's cynical comment on Infertility tutorial

More photos : http://picasaweb.google.co.uk/abadisufaat2/OGEOB

Oh very young

The first song that hooked me up was 'Wild World'. It was many many years ago, I think back in primary school. One day I noticed the tunes on radio before I turned to my mum asking who is the singer, as she was born in that era. Cat Stevens is Yusuf Islam.

Moonshadow is coming. I wonder when this musical is going to our shores? Perhaps at KLPac? Heh I can only dream...

...



Oh very young
What will you leave us this time
Youre only dancing on this earth for a short while
And though your dreams may toss and turn you now
They will vanish away like your daddys best jeans
Denim blue fading up to the sky
And though you want them to last forever
You know they never will
You know they never will
And the patches make the goodbye harder still

Oh very young
What will you leave us this time
Therell never be a better chance to change your mind
And if you want this world to see a better day
Will you carry the words of love with you
Will you ride the great white bird into heaven
And though you want to last forever
You know you never will
You know you never will
And the goodbye makes the journey harder still

Oh very young
What will you leave us this time
Youre only dancing on this earth for a short while
Oh very young
What will you leave us this time

Ramadan & Syawal

Ramadan

Quoting from Bingregory.com:

The most depressing fact about Ramadan is to find out how many of your problems are not caused by the Satan.

Several objectives were achieved. Phew. I need to do more tadabbur ie. comtemplate about the meaning of the verses, rather than boarding the express tajwid bullet train.

...

Shawal

// Haji H-assan bin Haji Abdul Salam.

From Aidilfitri 14302009

// The crowd

What a blast! More cousins than ever, and apparently more on their way to this very world. The whole battalion will be larger next year.

Alas, by next year insha Allah I'll be working, so donating few duit rayas will be a new routine for eid. I will not be too generous though, as children are not supposed to handle too many ringgits in their pockets. Either they will spend on rubbish or the parents will collect tax from them to pay for the bills.

// The daddys

Huh, I sense a strong smell of hypocrisy here. Back in my time, the minimal bounty would be in the range of few hundreds. Well, probably due to me being the early generation of the Haji Hassan's grandchildren. If you can relate to the law of supply and demand, you'd get it. Now, there's plenty of them - at least 65 and I've lost the count. Heh.

Don't ask how did I spend it. It's classified under OSA.

Anyway, I am grateful to be with my family this time around. Plus the extended ones. Second cousins. Third cousins. Wow. The family tree is really huge, as most of the mothers are grandmultiparous. Alhamdulillah.

// The mothers

ps - Sans fireworks, the Eid is kinda dull. Adult supervision should do the job, instead of this cute little creatures risking their arms and legs (its expensive because of its illegal by law) just to have more fun. Wait a minute, they can't be bothered anymore - there are plenty of electronics for them, so I better bring back PS3 or Wii next year!

Kesah Ajang Cerita Kita - Tukar Tiub

as per Tuan Isham at tukartiub.blogspot.com

KESAH AJANG CERITA KITA

adalah dikesahkan
ajang pun dilahirkan

lalu ajang dibesarkan
lalu ajang disekolahkan
lalu ajang diuji dan dipereksa
lalu ajang lulus ujian

gembiralah satu keluarga
gembiralah ajang se ajang-ajnangnya

ajang pun belajar lagi
diuji dan diperiksa
ajang pun luluslah

ajang pun dilamar bekerja
maka bekerjalah ajang
berbaris dan beratur dijalan raya
bangun dari tidor untuk menjual tenaga

sebulan sekali menerimah upah
lalu ajang membeli tv
untuk rehat dan bersenang hati

setiap hari beratur berbaris dijalan raya
bangun untuk menjual tenaga
dihujung minggu ajang berehat buntang mata menonton tv

duit terkumpul lagi
lalu membeli kereta sebelum mencari bini
berbaris beratus dijalan raya
bagun dari tidor untuk menjual masa dan tenaga
agar dapat bayar hutang kereta dan rumah sewa

lalu ajang pun berbinilah
bangun pagi berasak asak menjual tenaga
untuk membayar kereta dan rumah sewa
lalu ajang dan isteri menjadi cerdik
tak perlu bayar sewa kalau rumah dimiliki
lalu mereka berhutang lagi
untuk membayar kereta dan hutang bank
lalu mereka bangun pagi
berasak asak di jalan raya untuk memburuh
dan mengumpul duit nak jadi kaya

adalah dikesahkan
anak pun lahir dan dibesarkan
lalu anak di anjangkan sekali lagi
lalu anak diajar agar dia pun bangun pagi
bangun berasak-asak dijalan raya bersedia cekap
bijak pandai untuk menjadi hamba kepada kerja

akhirnya anjang tua dan hendak mati
anjang terlantar dikatil
lalu anjang teringat
sebuah buku cinta yang dibelinya tetapi lupa tidak dibaca
lalu anjang teringat sekuntum bunga mawar
yang dia terlupa baunya
lalu anjang teringat sebuah pantai landai
sebuah tasik permai sebuah gunung berhutan
saekor burung belibis terbang menyambar

lalu dia teringat gesekan biola
dan tiupan seruling sawah dan gaung
hutan dan pacat

ajang memanggil anak datang
ingin menyampai pesan
lalu mereka pun berkumpul
ajang hanya sempat berkata – jangan jadi bodoh –
semua tercengang semua hairan
mereka menangis
ajang telah hilang ingatan.

ajang mengulangi lagi – jangan jadi bodoh – lalu anjang mati

esoknya anak dan isteri bagun pagi pagi
berasak asak di jalan raya entah apa hendak dicari
mengulangi hidup berpusing-pusing
tak pernah sedar diri
hilang ingatan jadi injin bangun pagi
untuk beli kereta rumah dan tv

The way forward

Today my teacher showed a powerpoint on the projection of 'Doctor to Population' in Malaysia, much to everyone's surprise after his lecture on Endometrial cancer. Wow. Putting it simply, Malaysia will begin to produce doctors excessively by 2014, thanks to almost 20 med schools and more or less 400 recognised institutions gazetted by Malaysia Medical Council (MMC).

Well, it depends on how do you set the ratio up. Mind you, more medical centres will be built to correlate with Malaysia's ever growing population - yes I know our family size is getting smaller in comparison with our parents' heyday.

On the other hand, it allows us medical graduates to permeate and diversify even further, instead of solely focusing on pure healthcare ie. medical officer in hospitals and clinics (talking about becoming specialist, subspecialist and subsubspecialist). There's alot more opportunities out there, right?

Hmmm.... its just a degree anyway, a gate to lifelong learning - as illustrated by him : 'learning from womb to tomb'.

By the way, currently there is a ongoing debate on healthcare reform in the States. Things got pretty heated until few made noises (and smear campaign) against the 'socialised medicine' practiced by many Europeans. I wonder how is it going to be here in the future...

Ramadan

Azam Ramadan kali ini agak ringkas, of course recycle azam tahun lepas:

-Khatam POPPH

-Khatam al-Quran, balik-balik terlepas 1-3 juzuk...

-Buka puasa di masjid, surau dan hospital

-Tambah kualiti dan kuantiti majlis ilmu

-Shopping buku lagi (sambung azam tahun lepas)

-Habiskan buku yang telah dibeli tahun lepas (wow mati aku)

-Banyak muhasabah dan buat tindakan

Bukan setakat cerita alkohol di Selangor

Mari kita tonton video ini:



While on an official visit to a Middle East sheikdom to finalize a major contract for a UK firm, the Minister manages to get himself into trouble on several fronts. Learning that the country is dry, he arranges for liquor to be available on the sly. When they are presented with an expensive 17th century antique bowl, Mrs. Hacker gets Bernard Woolley to get the object valued at less than £50 allowing her to keep the gift. When the Minister learns that bribes were likely paid to obtain the contract, he insists that there be a full public inquiry. A little reminder from Sir Humphrey sets things straight.

Part 2
Part 3

Hacker: Are you saying that winking at corruption is government policy?
Sir Humphrey: No, no, Minister! It could never be government policy. That is unthinkable! Only government practice.

Hacker: You're a cynic, Humphrey!
Sir Humphrey: A cynic is what an idealist calls a realist.

Salvaging Precious Data

Hard drives fail just like any other appliances. If you browse thru the specs, often it says something like MTBF 100k hours. That's 'Mean Time Before Failure'. Unfortunately extreme condition and prolonged operation makes 'aging' of hard drives accelerates.

Now the problem is, how to salvage all data residing inside the failed drive?

Since I'm avid Mac OS X user, I'd recommend DiskWarrior. However, my effort to recover my precious has yet to bear any fruits...

Pengajaran: Rajin-rajinlah backup dengan burn DVD!

Alleycats - Soal Kahwin

Tahun ini banyak sungguh jemputan yang diterima.



Dengar ini teman-teman
Kata-kata buat pedoman
Kalau salah oh maafkan
Dalam hati jangan simpan

Ku bicara soal kahwin
Bukan soal main-main
Kalau ada keinginan
Fikir dulu sebelum lakukan

Orang kahwin,kita kahwin
Orang senang,kita berhutang
Dari itu sabar-sabar
Agar tidak kau berlapar

Selalu adanya penceraian
Kerana tiada bersefahaman
Atau fikiran belum matang
Sudah ingin nak berumah tangga

Kalau sudah ada jodoh
Apa hendak di katakan
Tunai saja keinginan
Berpandukan keimanan

Hai nak muda,hai perawan
Hidup ini, bukan sehari
Cari jalan,meyakinkan
Agar tak menyesal nanti

Apa yang tak ingin ku melihat
Hari ini kahwin esok bercerai
Bagiku kalau terjadinya
Ramai akan menjadi janda

Lagu ini hanya lagu
Untuk hibur bukan mengata
Yang tersinggung maaf saja
Kami hanya insan biasa
Maaf saja (oh maafkan)
Maaf saja (oh maafkan)

Rumah Warga Emas

//Rumah Orang-orang Tua Permatang Tok Gelam

Minggu lepas terpapar editorial British Medical Journal berkenaan rumah warga emas. Sewaktu latihan di Jabatan Psikiatri dahulu, acapkali saya bertemu pesakit sebaya dengan datuk dan nenek sendiri. Perasaan terus menjadi lain macam...

"Seorang ibu boleh menjaga 10 orang anak, tapi tidak semestinya 10 orang anak boleh menjaga seorang ibu.", pesan kebanyakan guru-guru di sekolah bergema di kotak fikiran.

Dalam surah at-Tin juga disebut yang manusia dicipta oleh Allah sebagai "makhluk yang terbaik, dan kemudiannya berubah mengambil tempat sebagai ciptaan terendah". Ulamak Ibnu Kathir menghuraikan maksud ayat tersebut sebagai peringatan tentang hari tua kita. Semasa kita masih kecil, ibu-bapalah yang menjaga makan-minum, memakaikan lampin dan selainnya sehingga kita membesar. Kitaran itu akan kembali sewaktu jika mencecah usia emas nanti. Fisiologi kita bakal melangkah ke era degeneratif - kita pulang ke alam kanak-kanak, dari segi jasmani, akal dan rohani. Bahasa mudahnya, 'nyanyuk'.

Pada suatu hari yang lain, seorang pesakit pernah merintih mencerita yang anak-anaknya berebut hartanya. Terus terdiam dan kelu lidah saya ketika itu...

.....

Published 4 August 2009, doi:10.1136/bmj.b2683
Cite this as: BMJ 2009;339:b2683

Editorials

Do not-for-profit nursing homes provide better quality?

Possibly, but current evidence is too weak to prove a causal association

In the linked systematic review (doi:10.1136/bmj.b2732), Comondore and colleagues assess the relation between profit status and the quality of care in nursing homes and conduct a meta-analysis of four quality measures.¹ The association between profit status and the quality of health care has been controversial for decades. The controversy stems partly from theoretical ambiguity and partly from lack of definitive empirical evidence. In theory, not-for-profit healthcare providers may provide a higher quality of care because their mission might include quality and because they do not need to divert resources to shareholders and taxes. On the other hand, for-profit providers may feel greater pressure to compete on price and quality, and this may result in higher quality care that is also more efficient. Unfortunately, rigorous testing of these competing theories is limited because it is impractical to conduct randomised controlled trials of profit status. Methods to mimic randomisation in observational studies (for example, instrumental variables²) are not always viable. Thus, empirical evidence cannot determine with certainty which theory is closer to the truth.

The nursing home sector is no exception to this controversy. Comondore and colleagues report that existing studies predominantly favour not-for-profit nursing homes, in that 40 of 82 studies showed significantly better quality in non-profit making homes. The meta-analysis favoured such homes for two of four outcomes; differences between the other outcomes were not significant. An important benefit of this review is that the authors were able to compare these results with similar reviews they conducted on hospitals and dialysis centres, both of which also showed higher quality in not-for-profit organisations.^{3 4} What is most remarkable about the results, however, is the inconsistency of the findings. Three of the studies reviewed showed significantly better quality in for-profit homes, and the remaining 39—almost half—were equivocal.

The inconsistency of the findings probably reflects the challenges of using observational data. No review or meta-analysis can overcome the empirical limitations common to all the studies reviewed—we still do not know whether not-for-profit status is the reason for higher quality of care. In other words, if a for-profit nursing home became not-for-profit, would its quality improve? The authors note this caveat, but it is worthy of greater consideration in terms of practical implications.

The lack of causal evidence is particularly problematic in that most of the studies were conducted in the United States, where the relation between nursing home profit status and payer mix is unique among healthcare sectors. Whereas not-for-profit status is normally associated with a community oriented mission, including care for the indigent, which would justify the tax exemption status, not-for-profit nursing homes in the US tend to focus on the clinically more severe and financially more lucrative end of the payer spectrum.⁵ For-profit facilities usually have a less lucrative payer mix and take on a larger proportion of (indigent) Medicaid beneficiaries. Thus, it could be argued that differences in quality stem from differential revenues rather than mission or diversion of resources to shareholders. Indeed, not-for-profit nursing homes with large Medicaid populations often provide a similar level of quality to that of for-profit homes.^{6 7} It could be that inadequate risk adjustment confounds the association, because for-profit and not-for-profit nursing homes tend to have different populations in terms of clinical needs.

The degree to which this uncertainty over causality matters depends largely on perspective. To prospective nursing home residents, their families, and care providers concerned about placement in a high quality nursing home, not-for-profit status may act as an indicator of high quality care. The reasons for higher quality in not-for-profit homes are largely irrelevant. Consumers already seem to be guided by this indicator,^{5 8} although it should be supplemented with personal experience in visiting the home and monitoring care.

From a policy perspective, the uncertainty over causality matters a great deal. It is not at all clear, for example, that banning for-profit providers from the nursing home sector would raise quality. It might, but many factors other than profit status have been strongly linked to the quality of nursing home care, such as the proportion of residents on Medicaid and the extent of poverty in the surrounding neighbourhood.⁷ Facilities that change profit status will probably maintain these other characteristics. Thus, if differences in quality between for-profit and not-for-profit nursing homes stem at least in part from differences in revenues rather than mission, eliminating for-profit homes may do little to eliminate differences in quality.

Experimental data—data from a situation in which nursing homes are forced to change profit status—are needed to increase our understanding of the causal association between profit status and the quality of nursing homes. Comondore and colleagues note that many European countries with historically public, not-for-profit, healthcare systems are now considering privatisation. Although current evidence is too limited to inform the potential effect of such a policy change on quality of care, the policy change itself could provide useful experimental data.

Cite this as: BMJ 2009;339:b2683

R Tamara Konetzka, assistant professor

¹ University of Chicago, Department of Health Studies, 5841 S Maryland, MC2007, Chicago, IL 60637, USA

konetzka@uchicago.edu

Research, doi:10.1136/bmj.b2732

---

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, et al. Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis. BMJ 2009;339:b2732.[Abstract/Free Full Text]
2. McClellan M, McNeil BJ, Newhouse JP. Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables. JAMA 1994;272:859-66.[Abstract/Free Full Text]
3. Devereaux PJ, Choi PT, Lacchetti C, Weaver B, Schunemann HJ, Haines T, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ 2002;166:1399-406.[Abstract/Free Full Text]
4. Devereaux PJ, Schunemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, et al. Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA 2002;288:2449-57.[Abstract/Free Full Text]
5. Spector WD, Selden TM, Cohen JW. The impact of ownership type on nursing home outcomes. Health Econ 1998;7:639-53.[CrossRef][Web of Science][Medline]
6. Konetzka RT, Spector W, Shaffer T. Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia. Med Care 2004;42:1001-8.[CrossRef][Web of Science][Medline]
7. Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. Milbank Q 2004;82:227-56.[CrossRef][Web of Science][Medline]
8. Chou SY. Asymmetric information, ownership and quality of care: an empirical analysis of nursing homes. J Health Econ 2002;21:293-311.[CrossRef][Web of Science][Medline]

Kreatif dan Kertas

Karya-karya sebegini sememangnya buatan tangan 100%. Itu jangkaan sayalah. Mungkin sekarang teknologi kertas sudah pun canggih, dan hasil seni seperti ini boleh dibuat secara besar-besaran.

Hmmm... Beberapa kali saya terfikir jika kisah-kisah Nabi dan sahabat diceritakan dalam bentuk "pop-up book". Hal komtemporari barangkali disambut baik, namun perlu diperincikan lagi, supaya ia menjadi syariah-compliant. 

Yalah, setahu saya, tidak dibenarkan menggambarkan nabi dan rasul dalam Islam. Sahabat dan tabiin mungkin boleh.

Paling tidak cerita-cerita rakyat Malaysia seperti Pak Pandir, Si Luncai, dan Malim Kundang, dapat diterbitkan dalam bentuk sebegini. 

Realism?

Nota kaki: Lisa Hannigan adalah ahli muzik yang sedang masyhur di Ireland sejak pertengahan 2008. Muzik video di atas bertajuk 'Lille', nama sebuah pekan di Perancis. Hmmm... Beliau menulis dan menggubah sendiri semua lagu dalam album sulung Sea Sew. Wow ini macam reviu artis pula.

TB or not TB?

TB or not TB? That's really a must-know-question for medical students.