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Background Patient safety is a fundamental concern in healthcare, especially in high-risk settings such as operating theaters, where there is an increased likelihood of adverse events. Nonetheless, studies within the operating theater setting remain limited. This study examined the influence of organizational and individual factors, and the moderating effects of job position, gender, and experience toward patient safety culture among perioperative staff at Sarawak General Hospital (SGH) in Malaysia. Methods A cross-sectional study design was employed, involving 137 perioperative staff members, including doctors and nurses, selected through proportionate stratified sampling. The Safety Attitude Questionnaire-Operating Room (SAQ-OR) and Hospital Survey on Patient Safety Culture (HSOPSC) was adapted in this study. The responses were analyzed via descriptive analysis and partial least square-structural equation modeling (PLS-SEM). Results Most respondents (67.2%) were registered nurses. The stress recognition dimension had the highest mean positive response rate at 73.0%, whereas the perceptions of the management dimension had the lowest at 22.6%. The study findings revealed a significant positive relationship between individual factors and the perception of patient safety culture (β = 0.389, p  = 0.008). In contrast, the association between organizational factors and the perception of patient safety culture was positive but not significant (β = 0.293, p  = 0.054). The moderating effects of position (β = 0.048, p  = 0.572), gender (β = 0.183, p  = 0.515), and years of experience in a specialty (β = −0.103, p  = 0.187) were also nonsignificant. Conclusion Overall, the perception of patient safety culture in the SGH operating theater was perceived as moderate, with substantial room for improvement. The lowest positive response rate in the management dimension implies the need for the organization to address staffing shortage issues and improve workplace support to increase patient safety. Individual factors, such as job satisfaction and stress recognition, were significantly associated with these perceptions. With a coefficient of determination (R²) value of 42.6% in this structural model, additional influencing factors may be relevant. Future studies should explore influences such as government policies, budget allocation, and technological advancements to further enhance patient safety culture in operating theaters.

Mass Casualty Incidents (MCIs) involving high-speed passenger ferries (HSPFs) may result in the dual-wave phenomenon, in which the emergency department (ED) is overwhelmed by an initial wave of minor injuries, followed by a second wave of more seriously injured victims. This study aimed to characterize the time pattern of ED presentation of victims in such accidents in Hong Kong. All HSPF MCIs from 2005 to 2015 were reviewed retrospectively, with the time interval from accident to ED registration determined for each victim. Multivariable linear regression was used to identify independent factors associated with the time of ED presentation after the accidents. Eight MCIs involving 492 victims were identified. Victims with an Injury Severity Score (ISS) ≥ 9 had a significantly shorter median time interval compared to those with minor injuries. An ISS ≥ 9 and evacuation by emergency service vessels were associated with a shorter delay in ED arrival, whereas ship sinking, accident at nighttime, and a longer linear distance between the accident and receiving ED were associated with a longer delay. The dual-wave phenomenon was not present in HSPF MCIs. Early communication is the key to ensure early resource mobilisation and a well-timed response.

Background: The indications for awake craniotomy now spans from resection of tumours at eloquent areas of the brain, deep brain stimulation and treatment of aneurysms to name a few. In the region of East Malaysia where patients have various ethnic backgrounds and native languages, planning and execution of these procedures can be somewhat challenging. Methods: This is a retrospective analysis of 11 awake surgeries conducted by the Department of Neurosurgery in Sarawak. The indications for awake craniotomy surgery in our sample population were intra-axial lesions in eloquent regions involving important cortical areas and subcortical tracts which were at risk of damage during tumour excision. Patients were assessed for intra-operative and post-operative neurological deficits. Results: Eleven patients aged 20 years old70 years old were included in this series. All patients were diagnosed with lesions in eloquent areas of the brain requiring surgical excision. Patients were of various ethnic backgrounds. The spoken language of these patients also varied based on their ethnicity. The histopathological diagnosis of nine patients were consistent with gliomas with three being of high grade. Three patients (27%) developed intra-operative deficits that were not present pre-operatively. Conclusion: This case series serve to demonstrate the feasibility of awake craniotomies even in centres without vast experiences in awake surgeries and ideal adjuncts which in comparison may be readily available in different centres. Although careful patient selection has been emphasised, it is a difficult feat in a region consisting of at least 30 different ethnic groups with distinct languages and cultures.

IntroductionUndiagnosed diabetes is a global health issue. Previous studies have estimated that about 24.1%–75.1% of all diabetes cases are undiagnosed, leading to more diabetic complications and inducing huge healthcare costs. Many current methods for diabetes diagnosis rely on metabolic indices and are subject to considerable variability. In contrast, a digital approach based on retinal image represents a stable marker of overall glycemic status.Research design and methodsOur study involves 2221 subjects for developing a classification model, with 945 subjects with diabetes and 1276 controls. The training data included 70% and the testing data 30% of the subjects. All subjects had their retinal images taken using a non-mydriatic fundus camera. Two separate data sets were used for external validation. The Hong Kong testing data contain 734 controls without diabetes and 660 subjects with diabetes, and the UK testing data have 1682 subjects with diabetes.ResultsThe 10-fold cross-validation using the support vector machine approach has a sensitivity of 92% and a specificity of 96.2%. The separate testing data from Hong Kong provided a sensitivity of 99.5% and a specificity of 91.1%. For the UK testing data, the sensitivity is 98.0%. The accuracy of the Caucasian retinal images is comparable with that of the Asian data. It implies that the digital method can be applied globally. Those with diabetes complications in both Hong Kong and UK data have a higher probability of risk of diabetes compared with diabetes subjects without complications.ConclusionsA digital machine learning-based method to estimate the risk of diabetes based on retinal images has been developed and validated using both Asian and Caucasian data. Retinal image analysis is a fast, convenient, and non-invasive technique for community health applications. In addition, it is an ideal solution for undiagnosed diabetes prescreening.

More than 1000 homes across Victoria were still without power last night, almost 24 hours after a violent windstorm that left a trail of damage estimated at more than $3 million.

Background Malignant peripheral nerve sheath tumors (MPNST) are a rare form of soft tissue sarcoma with few studies reporting on patient outcomes and prognostic variables. Methods A retrospective review of 175 patients diagnosed with MPNST from 1985 to 2010 was performed. Patient, tumor, and treatment characteristics were evaluated to identify prognostic variables. Results The median age of our study population was 44 years, and 51% were female. Median tumor size was 6 cm, and 61% of patients had high-grade tumors. Tumors were most commonly located on the extremities (45%), then trunk (34%) and head/neck (19%). The majority of patients underwent surgical resection (95%) and adjuvant treatment with chemotherapy (6%), radiation (42%) or both (22%). Margin status was R0 in 69%, R1 in 2%, R2 in 9%, and unknown in 20%. The local recurrence rate was 22%, and 5- and 10-year disease-specific survival (DSS) were 60% and 45%, respectively. On univariate analysis, no predictors for local recurrence were identified. Tumor size ≥5 cm, high tumor grade, tumor location, presence of neurofibromatosis type 1, local recurrence, and adjuvant chemotherapy were all associated with DSS. On multivariate analysis, size ≥5 cm [hazard ratio (HR) = 6.1, 95% confidence interval (CI) 1.5–25.0], local recurrence (HR = 4.4, 95% CI 1.7–11.4), high tumor grade (HR = 3.8, 95% CI 1.1–13.2), and truncal location (HR = 3.7, 95% CI 1.1–12.7) were poor prognostic indicators for DSS. Conclusions High tumor grade and tumor size ≥5 cm predict adverse DSS for MPNST. In the context of a multidisciplinary treatment regimen, local recurrence and survival outcomes at 5 and 10 years were better than previously reported for MPNST.