The Journal of Medicine, Law & Public Health

Myxoedema Coma Precipitated by Diabetic Ketoacidosis and Septic Shock: a Case Report

Rizq Badawi, Ahmed Alsuliamani, Abdullah Alhejaili , Eyad Alnemer — Wed, 27 Mar 2024 00:00:00 -0700

Myxoedema coma (or myxoedema crisis) is a severe and potentially fatal form of decompensated hypothyroidism with an underlying cause. A low index of suspicion and a search for triggering factors should be the first step in dealing with the condition at an early stage. Myxoedema coma should be suspected in patients who present with hypothermia, altered mental status, and coma, even if hypothyroidism has not previously been recognized. The symptoms of hypothyroidism decompensation may mistakenly be attributed to its precipitating factors, which may include sepsis, cardiac failure, myocardial infarction, cerebrovascular accident, anaesthetic, sedatives, antidepressant medications, or metabolic and electrolyte abnormalities. Here, we present a case of myxoedema coma with two major underlying precipitating causes: septic shock and diabetic ketoacidosis.

Safe Handling of Oral Chemotherapeutic Agents Among Nurses in Oncology Units

Diana Lalithabai, BahaAldeen Tahar Mahmood , Heba Jamal Salamah — Tue, 12 Mar 2024 00:00:00 -0700

Background: Several concerns have been raised in the literature regarding nurses’ awareness of the safe handling of oral chemotherapeutic agents (OACAs). This research aims to assess such awareness among nurses working in oncology units.

Methods: The study utilised a cross-sectional descriptive design, and was conducted between July 2022 and March 2023. Data were collected via a structured questionnaire from a previous study, with 34 variables grouped into four categories.

Results: Our study indicated that most nurses knew how to safely handle chemotherapeutic drugs. Correct responses per category were: storage, 77.7%; handling, 65.86%; disposal of contaminated materials, 94.45%; and education and training, 89.68%. Nurses with > 10 years’ experience had higher scores than those with < 10 years; the difference was significant (p = 0.039). Likewise, there was a significant difference (p = 0.002) in mean scores between nurses who had received training on the safe handling of chemotherapeutic drugs (92.1 ± 20) and those who had not (76.8 ± 30.7).

Conclusion: The study indicates that years of experience and roles at work have a significant impact on nurses’ knowledge about the storage of chemotherapeutic drugs. Overall, nurses with more experience and training scored significantly higher, suggesting that training is an effective way to improve knowledge and skills in this area. Furthermore, participation in this study might influence might influence nurses’ judgments when handling oral chemotherapeutic drugs and caring for cancer patients.

Public Health Law In Malaysia And The United States: Comparing Current Applications

Justen Han Wei Wong, Tahir Aris, Ismuni Bohari, Mohd. Zamre Mohd. Zahir — Mon, 11 Mar 2024 00:00:00 -0700

Background: The main objective of public health law is to pursue the highest possible level of physical and mental health in the population, consistent with the values of social justice.

Aims: To elaborate on Malaysia’s public health laws that share unique commonalities with those of the United States of America, due to both countries’ colonial past as part of the British Empire.

Methods: Historical review and analysis of current public health law issues in both nations.

Results: The United States of America gained full independence from the British Empire on 3 September 1783, while almost three years later, on 11 August 1786, the Union Jack was raised on the island of Pulau Pinang in Malaysia. When the colonies first formed the United States, there was no national public health law; the American colonies adopted the English laws on the control of diseases. This is similar to Pulau Pinang, after the implementation of the Charter of Justice in 1807.

Conclusion: Current applications of the law, which include quarantine, sanitation, disease reporting, and vaccination,exhibit interesting similarities as well as differences between the United States and Malaysia.

A Review of Advance Directives

Lisa Kachina Poku — Mon, 11 Mar 2024 00:00:00 -0700

The use of an advance directive, when drafted in accordance with the MCA, allows a person the right to refuse specified treatment at a later stage of their life, should they become incapacitated. This means that they, rather than others, can determine what would be in their own best interest. However, even when a person has made an advance directive, their express wishes can be overruled by the court if they have acted in such a way, or there has been a change in circumstances, that is inconsistent with their advance directive. That is, in the event of clear inconsistencies with an advance directive, the court will rule in favour of the preservation of life. Thus, in certain circumstances, it may be justifiable for an advance directive not to be binding.

This review aims to evaluate the practices around advance healthcare directives in England and Wales. In particular, it focuses on advance directives for refusal of life-sustaining treatment, and how the courts interpret Section 25(2) (c) MCA in determining when an advance directive is no longer valid or applicable to the specified treatment as a result of inconsistencies subsequent to the document’s drafting. Furthermore, it contends that a mandatory capacity assessment prior to drafting an advance directive could eliminate contentious issues at a later stage.

In Focus: Clinical Imaging of the Median Arcuate Ligament through Cadaveric Exploration

Mon, 11 Mar 2024 00:00:00 -0700