Summary of case

patient, 7 year old girl, known case of ASD presented to AnE because of symptoms suggestive of bronchopneumonia. currently shows signs of cardiac failure with pulmonary hypertension.

detected with ASD since 1 1/2 years of age. deferred surgery but on six monthly follow - up at HSA.

previously child was known to be well and able to undergo normal daily activities (did not involved in vigorous exercise). family from low socioeconomic class. both parents work and earn rm1500 in total. have 4 children still schooling.

reason of parents not wanting surgery:
1) confused, dont fully understand condition
2) wanted alternative treatment
3) money?

TASKS

1. Ethical and legal issues concerning parents and doctors (MALAYSIA!!!!!! – mano)
2. Doctors role in advocating to child? - maze
1. Compare law in Singapore n Australia
3. Support (financial, support group, NGOs etc for pre and post surgery) - saree
4. Types of Congenital HD -christine
5. Pathophysiology ASD (now to future) yazid
6. Prognosis (with or without treatment) chris
7. Types of management for ASD (EBCP) alvin

first child, to mother of 27 years of age requested elective caesarian section at 36 weeks in Mersing. baby was flat with Apgar score 4'7' . baby proceeded to develop respiratory distress and possibly fitting. baby was going to be transferred to HSA for further treatment.

Issues:
1. Prematurity - mano
- Why did the baby come out flat/going to fit/respiratory distress in elective caesarian section?
- Timing of elective caesarian section
- (non ketotic hypoglycaemia of childhood)

2. Delay in treatment - what can happen? alvin
- neonatal transport compare australia and malaysia

3. What are the services available in a rural hospital compared to city hospital?
- what can you do as immediate care for the patient in a rural setting? yazid

4. antenatal complications resulting in low apgar score - tell us about apgars. maz

5. potential impact of transfer on mother and baby? chris

6. ethical issues surrounding mothers/doctors choice of auspicious date? christine

7. neonatal resuscitation - saree

ahmad ,17 y/o boy

IDDM 8 years age, PCx DKA

good compliance until 14 years age

complications:
diabetic retinopathy grade 2
microalbuminiria

social:
school performance bad


issues:
1) in adolescent malaysia/oz- etiology, epi mano
2) immediate/long term complications christine
3) perception of disease in different age group (below 10, above 10) yazid
4) management (educating patient) and coping strategies of chronic disease in adolescent alvin
5) compliance in adolescent chris
6) lifestyle and diet - restrictions; can and cannot do maze
7) cost of treatment (yearly......?) government subsidy for IDDM? (malaysia/australia) saree

Issues:
1. Pregnancy in a minor/teenager mano
- incidence, under what circumstances do they occur.
2. Family dynamics yazid
- disclosure of information
- are you going to send girl back to stepfather?
3. Homelessness and Financial Problems maz
- How does one deal with it?
- What problems arise?
- Where can they get support? Welfare in JB for homeless, pregnant
4. Substance Abuse in Adolescence chris
5. Ethical and Legal Rights saree
- Abortion? Is it allowed under these circumstances?
- Reporting etc
6. Unprotected sex christine
- what to do if someone who comes in after having unprotected sex?
----> tests, counselling
7. What are the options to offer the patient? ALVIN

issues to discuss
1. Breaking bad news
2. what they know _ add on
3. what are their options?
- abortions
- what happens if cont' pregnancy
- support available?
- prognosis of child
4. counseling on future pregnancies
5. involvement of family members.

Tasks
1.Epi+aetiology - christine
2. clinical features- saree
3. screening + prevention- antenatal, folate etc - alvin
4. Mx- immediate- chris
5. Complications+Mx- long-term- Yazid
6. ethics+law- abortions-options, what happens with conflicting opinions, compare msia+aust-Maze
7. Psychosocial, health policy- whats available, support available, compare msia+aust, mother's guilt -MANO!

1. How do you carry out a risk assessment? What do you ask? in terms of osce etc etc etc saree

2. CBT - discuss concepts of CBT and use in anxiety, panic and depression - Yazid

3. Types of psychotherapy - when do you which types??? which diseases do you use certain types? maz

4. EBCP - evidence of CBT in treating patients wit psychiatric conditions - you choose la what psych condition - BMD, depression wtv wtv alvin

5. The various people involved in psychotherapy - the different teams etc etc

6. Techniques of behaviour therapy - relaxation, exposure etc etc chrissie

7. ethical issues of imposing values in dynamic psychotherapy - read up in oxford.

Chris and mano choose which tasks you guys wana do. Choose between 5 & 7.