DESIGN: This study was designed as a retrospective cohort study.
SETTING AND PARTICIPANTS: In this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.
MAIN OUTCOME MEASURES: The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.
RESULTS: There were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.
CONCLUSIONS: The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.
METHODS: We systematically searched multiple databases to identify studies reporting incidence of antineoplastic-related cardiovascular toxicity in Asia published from inception to November 2018. Pre-specified subgroups were performed to explore heterogeneity and study quality assessed and reported according to PRISMA guidelines.
RESULTS: A total of 61 studies across 11 countries in Asia reported 8 types of cardiovascular toxicities were included. These studies mostly reported on adult populations, and usually examined cardiotoxicities related to anthracycline use. The most frequently reported cardiotoxicities were heart failure, electrocardiogram abnormalities and left ventricular dysfunction. The pooled estimated incidence of cardiotoxicity was 4.27% (95% CI: 3.53-5.07). Subgroup analysis showed higher incidence in middle income countries compared to high income countries.
CONCLUSIONS: Although robust incidence studies are sparse, cardiovascular complications affects approximately one in twenty cancer patients in Asia. This highlights a unique opportunity of cancer patients caring that need cardiologists and oncologist to become familiar with this emerging sub-specialty.
METHODS: We performed electrophysiologic, biochemical, and biophysical experiments to elucidate the molecular mechanism underlying calmodulin (CaM)-mediated Ca2+-dependent inactivation (CDI) of TRPC6. To address the pathophysiologic contribution of CDI, we assessed the actin filament organization in cultured mouse podocytes.
RESULTS: Both lobes of CaM helped induce CDI. Moreover, CaM binding to the TRPC6 CaM-binding domain (CBD) was Ca2+-dependent and exhibited a 1:2 (CaM/CBD) stoichiometry. The TRPC6 coiled-coil assembly, which brought two CBDs into adequate proximity, was essential for CDI. Deletion of the coiled-coil slowed CDI of TRPC6, indicating that the coiled-coil assembly configures both lobes of CaM binding on two CBDs to induce normal CDI. The FSGS-associated TRPC6 mutations within the coiled-coil severely delayed CDI and often increased TRPC6 current amplitudes. In cultured mouse podocytes, FSGS-associated channels and CaM mutations led to sustained Ca2+ elevations and a disorganized cytoskeleton.
CONCLUSIONS: The gain-of-function mechanism found in FSGS-causing mutations in TRPC6 can be explained by impairments of the CDI, caused by disruptions of TRPC's coiled-coil assembly which is essential for CaM binding. The resulting excess Ca2+ may contribute to structural damage in the podocytes.
BACKGROUND: Because of the demanding nature of their work, nurses often have significantly high levels of stress, anxiety and depression. MBSR has been reported to be an effective intervention to decrease psychological distress.
DESIGN: Systematic review.
METHODS: The databases included were Science Direct, PubMed, EBSCO host, Springer Link and Web of Science from 2002 to 2018. Interventional studies published in English that used MBSR among nurses to reduce their psychological distress were retrieved for review. The PRISMA guideline was used in this systematic review. The included studies were assessed for quality using "The Quality Assessment Tool For Quantitative Studies (QATFQS)."
RESULTS: Nine studies were found to be eligible and included in this review. Many benefits, including reduced stress, anxiety, depression, burnout and better job satisfaction, were reported in these studies.
CONCLUSION: The adapted/brief versions of MBSR seem promising for reducing psychological distress in nurses. Future research should include randomised controlled trials with a larger sample size and follow-up studies. There should also be a focus on creative and effective ways of delivering MBSR to nurses.
RELEVANCE TO CLINICAL PRACTICE: The results of this review are substantial for supporting the use of MBSR for nurses' psychological well-being.
OBJECTIVE: This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.
METHODS: All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.
RESULTS: Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.
CONCLUSION: After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.
Methods: We retrieved the in-course continuous assessment (ICA) and final professional examination results of 3 cohorts of medical students (n = 245) from the examination unit of the International Medical University, Seremban, Malaysia. The ICA was 3 sets of composite marks derived from course works, which includes summative theory paper with short answer questions and 1 of the best answers. The clinical examination includes end-of-posting practical examination. These examinations are conducted every 6 months in semesters 6, 7 and 8; they are graded as pass/fail for each student. The final professional examination including modified essay questions (MEQs), 1 8-question objective structured practical examination (OSPE) and a 16-station objective structured clinical examination (OSCE), were graded as pass/fail. Failure in the continuous assessment that can predict failure in each component of the final professional examination was tested using chi-square test and presented as odds ratio (OR) with 95% confidence interval (CI).
Results: Failure in ICA in semesters 6-8 strongly predicts failure in MEQs, OSPE and OSCE of the final professional examination with OR of 3.8-14.3 (all analyses p< 0.001) and OR of 2.4-6.9 (p<0.05). However, the correlation was stronger with MEQs and OSPE compared to OSCE.
Conclusion: ICA with theory and clinical examination had a direct relationship with students' performance in the final examination and is a useful assessment tool.
METHODS: We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis.
RESULTS: We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent.
CONCLUSIONS: We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.