Taiping Hospital, formerly known as Yong Wah Hospital was one of the first hospitals established in Malaysia. Located at Jalan Taming Sari (Main Road) near the commercial town centre, it is one of the biggest hospitals in Malaysia and is the second biggest in the State of Perak. The hospital is strategically situated 80 km from Ipoh and 85 km from Penang and was able to serve the northern states of Malaysia.
The Malaysian public healthcare system is under growing strain, which is driven by an aging population and the rising burden of chronic non-communicable diseases (NCDs). These shifts have placed added pressure on hospitals, particularly in handling inpatient discharges. To respond to this challenge, the study set out to build a machine learning-based forecasting model that can predict discharge volumes. Hospital Taiping, one of the key government hospitals in northern Malaysia, was selected as the case study. Monthly inpatient discharge data from 2019 to 2023 formed the foundation for building predictive models. To strengthen the dataset, additional temporal features were engineered, including lagged discharge counts, rolling averages and seasonal indicators. Three machine learning models, namely Random Forest (RF), XGBoost and Support Vector Regression (SVR), were then trained and fine-tuned through Bayesian Optimization. Model performance was evaluated using coefficient of determination (R²), Root Mean Square Error (RMSE), Mean Absolute Scaled Error (MASE) and Mean Absolute Percentage Error (MAPE). The best-performing model was prospectively validated with actual discharge data from 2024. The Random Forest model demonstrated the lowest RMSE of 177.85, a MAPE of 3.23% and the highest R² of 0.43. Prospective validation using 2024 data confirmed its robustness in forecasting inpatient discharges. The study developed and validated a machine learning model to forecast inpatient discharge volumes in government hospitals across the Northern Region of Malaysia. It also contributes to both methodology and practical application by providing a forecasting framework that supports more informed hospital planning and resource management.
BACKGROUND AND AIM:Proton pump inhibitors (PPIs) are integral to managing many gastrointestinal conditions. However, the prevalent inappropriate PPI prescription across Southeast Asia (SEA) is concerning. Given the absence of locally tailored recommendations to inform clinical practice, this consensus document aims to provide recommendations for PPI rationalization to healthcare providers in the region. METHODS:The SEA PPI Rationalization Working Group is steered by 14 experts practicing across Malaysia, Thailand, Singapore, Vietnam, the Philippines, and Indonesia. The experts convened to review existing evidence and develop recommendations and to conduct an anonymous voting as per the modified Delphi method. RESULTS:Twenty statements were formulated, focusing on areas of (i) extent and impact of PPI overprescription (four statements), (ii) benefits and barriers to PPI rationalization (two statements), (iii) START/STOPP criteria for PPI (nine statements), and (iv) PPI rationalization strategies (five statements). The consensus document underscores the widespread inappropriate long-term PPI prescription across SEA, which may have adverse clinical outcomes. Although rationalizing PPI use may be beneficial, the experts acknowledge the challenges of implementing PPI rationalization. The experts also outlined specific indications to guide PPI initiation and advised regular review to rationalize a PPI when no longer indicated. This is followed by PPI rationalization strategies, including shared decision-making, prescribing alginate as a rescue therapy in gastroesophageal reflux disease, and further evaluation for reinitiation of PPI when clinically warranted. CONCLUSIONS:This consensus document serves to improve PPI prescribing and deprescribing practices in SEA and to provide recommendations on rationalization strategies.
Primary external auditory canal cholesteatoma (EACC) is a rare condition characterized by keratinizing squamous epithelium causing progressive bony erosion of the external auditory canal. Bilateral primary EACC is exceptionally uncommon. We report a 49-year-old woman who presented with progressive bilateral hearing loss, intermittent otorrhea, and dull otalgia. Otoscopic examination revealed keratin debris and canal wall erosion in both ears. High-resolution computed tomography demonstrated bilateral posterior canal wall erosion without middle ear involvement. She had no history of ear surgery, trauma, or systemic disease. The left ear was managed with examination under anesthesia and toileting, while the right ear required modified radical mastoidectomy with type III tympanoplasty and mastoid cavity obliteration. Histopathology confirmed cholesteatoma. This case highlights the importance of distinguishing EACC from other external canal pathologies and emphasizes early imaging and individualized management to prevent complications and ensure favorable outcomes.
Heart failure with reduced ejection fraction (HFrEF) poses a significant clinical and economic burden in Malaysia, particularly in Perak. Iron deficiency (ID) in HFrEF is associated with increased hospitalization risk. While international guidelines recommend intravenous ferric derisomaltose (FDI), its economic viability within Perak's public hospitals remains undefined. This study estimated the 3-year budget impact of introducing FDI therapy for HFrEF patients with ID in Perak public hospitals from the Malaysian Ministry of Health perspective. An Excel-based budget impact model compared a "World-with-FDI" scenario against the current standard of care (no intravenous iron) over a 3-year horizon (2026-2028). The eligible cohort was estimated using demographic projections, regional prevalence registries (Asian-heart failure [HF], MY-HF), and public sector utilization rates. Clinical efficacy (rate ratio of hospitalization) and dosing parameters were derived from the IRONMAN trial, incorporating drug acquisition and hospitalization costs. Deterministic one-way sensitivity analyses tested parameter uncertainties. Phased introduction of FDI required negligible investment of RM 2686 in Year 1. During maintenance dosing, savings from reduced hospitalizations significantly outweighed drug acquisition costs, generating net savings of RM 442,279 in Year 2 and RM 889,529 in Year 3. The 3-year cumulative savings totaled RM 1.33 million. Sensitivity analyses revealed the model is highly sensitive to hospitalization costs; prioritizing high-risk patients amplified Year 3 savings to over RM 2 million, while low-cost, stable cohorts resulted in a net budget deficit. FDI is cost-saving for managing HFrEF with ID in Perak. Strategic patient selection targeting high-utilization cohorts maximizes financial sustainability, while single-visit dosing offers operational efficiencies.
Epidermal cyst is a very common cutaneous lesion. Giant epidermal cyst is defined by its size of more than 5 cm in diameter. Buttock is an unusual site for epidermal cyst. Malignant transformation of epidermal cyst is an exceedingly rare phenomenon. Clinicians should be vigilant of such entity especially in giant epidermal cyst despite a seemingly benign imaging finding. Long term outcome of surgery for such tumor remains an uncertainty.
