Displaying publications 1 - 20 of 32 in total

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  1. Chan CM, Abdul Latiff AH, Noh LM, Ismail IH, Abd Hamid IJ, Liew WK, et al.
    Front Immunol, 2023;14:1209315.
    PMID: 37529038 DOI: 10.3389/fimmu.2023.1209315
    INTRODUCTION: With increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians' opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries.

    METHODS: We adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries.

    RESULTS: Regionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer.

    DISCUSSION AND CONCLUSION: Our study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.

  2. Mohajer S, Li Yoong T, Chan CM, Danaee M, Mazlum SR, Bagheri N
    BMC Med Educ, 2023 Feb 15;23(1):114.
    PMID: 36793032 DOI: 10.1186/s12909-023-04097-4
    BACKGROUND: Professional self-concept is one of the important outcomes of nursing professionalism. There is a lack of adequately planned curriculum may limit nursing students' practical knowledge, skills and professional self-concept in providing comprehensive geriatric-adult care and promoting nursing professionalism. Professional portfolio learning strategy has allowed nursing students to continue professional development and enhance nursing professionalism in professional clinical practice. However, there is little empirical evidence in nursing education to support the use of professional portfolios in blended learning modality among internship nursing students. Therefore, this study aims to examine the effect of the blended professional portfolio learning on professional self-concept among undergraduate nursing students during Geriatric-Adult internship.

    METHODS: A quasi-experimental study two-group pre-test post-test design. A total of 153 eligible senior undergraduate students completed the study (76 in the intervention group and 77 in the control group). They were recruited from two Bachelor of Sciences in Nursing (BSN) cohorts from nursing schools at Mashhad University of Medical Sciences (MUMS), in Iran, in January 2020. Randomization was undertaken at the level of school via a simple lottery method. The intervention group received the professional portfolio learning program as a holistic blended learning modality, though the control group received conventional learning during professional clinical practice. A demographic questionnaire and the Nurse Professional Self-concept questionnaire were used for data collection.

    RESULTS: The findings imply the effectiveness of the blended PPL program. Results of Generalized Estimating Equation (GEE) analysis was indicated significantly improved professional self-concept development and its dimensions (self-esteem, caring, staff relation, communication, knowledge, leadership) with high effect size. The results of the between-group comparison for professional self-concept and its dimensions at different time points (pre, post and follow up test) showed a significant difference between groups at post-test and follow up test (p  0.05).The results of within-group comparison for both control and intervention showed that there were significant differences in professional self-concept and for all its dimensions across the time from pre-test to post-test and follow-up (p 

  3. Woo KT, Chan CM, Mooi CY, -L-Choong H, Tan HK, Foo M, et al.
    Clin. Nephrol., 2010 Nov;74(5):372-83.
    PMID: 20979946
    This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.
  4. Al Maghaireh DF, Abdullah KL, Chan CM, Piaw CY, Al Kawafha MM
    J Clin Nurs, 2016 Oct;25(19-20):2745-2756.
    PMID: 27256250 DOI: 10.1111/jocn.13259
    To determine the feasibility and utility of a thematic analysis approach to synthesising qualitative evidence about parental experiences in the neonatal intensive care unit.
  5. Thiagarajan M, Chan CM, Fuang HG, Beng TS, Atiliyana MA, Yahaya NA
    Asian Pac J Cancer Prev, 2016;17(1):171-6.
    PMID: 26838205
    BACKGROUND: Much has been done to examine the psychological impact of cancer treatment, but it remains unclear to what extent anxiety and depression is related to symptom prevalence. The present study concerned the characteristics and frequency of distress as related to symptom prevalence in cancer patients undergoing chemotherapy in Malaysia.

    MATERIALS AND METHODS: Participants were 303 consecutive adult cancer patients undergoing chemotherapy in an academic medical center. The short form Memorial Symptom Assessment Scale (MSAS-SF), which covers three domains of symptoms (global distress, physical- and psychological symptoms) was used to cross-sectionally measure symptom frequency and associated distress via self-reporting. One-way ANOVA and t-tests were used to test mean differences among MSAS-SF subscale scores.

    RESULTS: Complete data were available for 303 patients. The mean number of symptoms was 14.5. The five most prevalent were fatigue, dry mouth, hair loss, drowsiness and lack of appetite. Overall, symptom burden and frequency were higher than in other published MSAS-SF studies. Higher symptom frequency was also found to be significantly related to greater distress in cancer patients undergoing chemotherapy.

    CONCLUSIONS: Patients undergoing chemotherapy suffer from multiple physical and psychological symptoms. Better symptom control or palliative care is needed. Greater frequency of reported symptoms may also indicate a subconscious bid by patients for care and reassurance - thus tailored intervention to manage distress should be offered.

  6. Jamaludin TSS, Nurumal MS, Ahmad N, Muhammad SAN, Chan CM
    Enferm Clin, 2021 04;31 Suppl 2:S58-S62.
    PMID: 33849230 DOI: 10.1016/j.enfcli.2020.10.019
    This systematic review aimed to appraise and synthesize the available evidence that examines the soft skill elements in clinical nursing assessment for undergraduate nursing students. This systematic review also is in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified based on the inclusion criteria with language filters but were limited to articles published from January 2000 to March 2019. Two reviewers independently conducted the quality assessment, data extraction, and analysis on all included studies. A total of 17 articles were included in this review. Studies showed that without developing adequate soft skill elements in the clinical skill assessment, students are graduating unprepared to be successful in the workplace. There is a need to consider and adopt soft skill elements in clinical skill assessment to improve the quality of nursing graduates and ultimately to create a positive impact on patient outcomes.
  7. Wee LH, West R, Mariapun J, Chan CM, Bulgiba A, Peramalah D, et al.
    Addict Behav, 2015 Aug;47:74-9.
    PMID: 25889913 DOI: 10.1016/j.addbeh.2015.03.021
    BACKGROUND: It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success.
    METHODS: A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed.
    RESULTS: The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used.
    CONCLUSIONS: Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used.
    KEYWORDS: Carbon monoxide; Predictors for abstinence; Smoking cessation; Success rates
  8. Wee LH, Binti Ithnin AA, West R, Mohammad N, Chan CM, Hasan Nudin SS
    J Subst Use, 2017 Jan 02;22(1):47-52.
    PMID: 28217031 DOI: 10.3109/14659891.2016.1143045
    Introduction: Little is known about how smokers respond cognitively and emotionally to the experience of "late" relapse after the acute withdrawal phase. This study assessed the kinds of thoughts and feelings that emerge in order to provide a basis for quantitative research assessing prevalence of different types of response and implications for future quit attempts. Methods: Face-to-face in-depth interviews were conducted among 14 people attending a quit smoking clinic in Malaysia who had relapsed after at least 6 weeks of abstinence. Transcripts were analyzed using thematic analysis to enable emergence of important aspects of the experience. Results: Following relapse, smokers often engaged in rationalizations and activities to minimize worry about the harmful effects of smoking by switching to a lower-tar cigarette, reducing the number of cigarette smoked, attempting to reduce cigarette smoke inhalation, comparing themselves with other smokers, and minimizing the health risks associated with smoking. In some cases, smokers retained a "non-smoker" identity despite having relapsed. Conclusion: Smoking relapsers rationalize their failure to quit and minimize their health risk in order to protect their image as non-smokers while it remains a source of identity conflict.
    Study site: Quit Smoking Clinic, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
  9. Fauziningtyas R, Chan CM, Pin TM, Dhamanti I, Smith GD
    Int J Older People Nurs, 2023 Sep;18(5):e12553.
    PMID: 37334471 DOI: 10.1111/opn.12553
    INTRODUCTION: The development of resident safety culture in nursing homes (NH) represents a major challenge for governments and NH owners, with a requirement for suitable tools to assess safety culture. Indonesia currently lacks suitable safety cultures scales for NH.

    OBJECTIVES: To evaluate the psychometric properties of the translated Indonesian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC-INA).

    METHODS: This study was a cross-sectional survey conducted using NHSOPSC-INA. A total of 258 participants from 20 NH in Indonesia were engaged. Participants included NH managers, caregivers, administrative staff, nurses and support staff with at least junior high school education. The SPSS 23.0 was used for descriptive data analysis and internal consistency (Cronbach's alpha) estimation. The AMOS (version 22) was used to perform confirmatory factor analysis (CFA) on the questionnaire's dimensional structure.

    RESULTS: The NHSOPSC CFA test originally had 12 dimensions with 42 items and was modified to eight dimensions with 26 items in the Indonesian version. The deleted dimensions were 'Staffing' (4 items), 'Compliance with procedure' (3 items), 'Training and skills' (3 items), 'non-punitive response to mistakes' (4 items) and 'Organisational learning' (2 items). The subsequent analysis revealed an accepted model with 26 NHSOPSC-INA items (root mean square error of approximation = 0.091, comparative fit index = 0.815, Tucker-Lewis index = 0.793, CMIN = 798.488, df = 291, CMIN/Df = 2.74, GFI = 0.782, AGFI = 0.737, p 

  10. Chan CM, Mahlaoui N, Sánchez Ramón S, Pergent M, Solis L, Prevot J, et al.
    Front Immunol, 2023;14:1151335.
    PMID: 37063889 DOI: 10.3389/fimmu.2023.1151335
    OBJECTIVE: To analyze the implementation of the Principles of Care (PoC) in primary immunodeficiencies (PID) in Southeast Asia (SEA) countries - six years after its call of action.

    METHODOLOGY: Using the newly developed PID Life Index software, the index of implementation of principles of care in the management of PIDs patients involving the six participating SEA countries (Cambodia, Indonesia, Malaysia, Vietnam, Thailand, and Philippines) were extracted. For each of the six separate principles, the index from the six countries will be compared and presented based on the calculated index.

    RESULTS: Comparative analysis of the six principles of care of PID in the SEA countries showed low diagnostic rate with minimal availability of diagnostic tests options. Generally, almost all SEA countries provide curative treatments, vaccines, and anti-infectious therapies although the reimbursement scheme varied in relieving patients' financial burden. We also highlighted the active involvement of patient organizations in SEA, with main areas of work focused on advocacy and increasing awareness among public and healthcare professionals.

    DISCUSSION AND CONCLUSION: It is applaudable that the SEA continent is gradually strengthening its work in management of PID, especially in Thailand and Vietnam. However, more emphasis must be placed among stakeholders in SEA countries towards successful implementation of the PoC for a holistic management of PID patients.

  11. Chong PP, Tung CH, Rahman NA, Yajima M, Chin FW, Yeng CL, et al.
    Acta Ophthalmol, 2014 Nov;92(7):e569-79.
    PMID: 25043991 DOI: 10.1111/aos.12427
    The aim of the study was to determine the prevalence of human papillomavirus (HPV) in primary and recurrent pterygia samples collected from different ethnic groups in the equatorial Malay Peninsula.
  12. Chan CM, Wan Ahmad WA, Md Yusof M, Ho GF, Krupat E
    Eur J Cancer Care (Engl), 2015 Nov;24(6):938-44.
    PMID: 25810106 DOI: 10.1111/ecc.12312
    Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds (P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival.
    Study site: Oncology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  13. Aizuddin AN, Chan CM, Anwar AR, Ong YX, Chin KY
    Int J Gen Med, 2021;14:3251-3257.
    PMID: 34267543 DOI: 10.2147/IJGM.S316360
    Purpose: Body mass index (BMI) is used universally to define obesity. Many studies have indicated that the current BMI cutoff value for obesity may be inaccurate in identifying individuals with excess body fat (BF) and at risk for cardiovascular diseases (CVD). This study aims to assess the performance of BMI in diagnosing obesity defined by BF percentage (BF%).

    Patients and Methods: A total of 136 participants who attended an annual health screening programme were recruited. The subjects completed the health examinations, including BMI, BF% and blood pressure measurement. A receiver operating curve (ROC) analysis was conducted to determine the optimal cutoff value of BMI in classifying obesity based on BF% (>25%).

    Results: The ROC analysis revealed that the optimal BMI cutoff value in classifying subjects with obesity based on BF% was 24.8 kg/m2. The agreement between the classification scheme based on the new BMI cutoff (>24.8 kg/m2) and BF% was higher (κ=0.722) compared to the standard BMI cutoff (>27.5 kg/m2) (κ=0.532). BMI 24.8 kg/m2 also had higher sensitivity (80.0%) than 27.5 kg/m2 (56.0%) in detecting subjects with high adiposity. The new BMI cutoff also showed a sensitivity of 63.9% in identifying subjects with hypertension compared to the standard cutoff (36.1%).

    Conclusion: The current definition of obesity based on BMI value needs to be reassessed by taking BF% into account. A new BMI cutoff point, 24.8 kg/m2 for obesity, can identify a higher percentage of Malaysian at risk for CVD.

  14. Chan CM, Wan Ahmad WA, Yusof MM, Ho GF, Krupat E
    Asian Pac J Cancer Prev, 2015;16(16):6895-8.
    PMID: 26514463
    BACKGROUND: We aimed to explore whether levels of patient-centredness, job satisfaction and psychological distress varied between oncology nurses and doctors.

    MATERIALS AND METHODS: In a cross-sectional study using self-administered questionnaires, a total of 24 nurses and 43 doctors were assessed for patient-centredness, psychological distress, and job satisfaction using the Patient-Practitioner Orientation Scale, Hospital Anxiety and Depression Scale, and Job Satisfaction Scale. Data were analysed using descriptive statistics, independent samples t-test and MANCOVA, with p<0.05 considered significant.

    RESULTS: Overall response rate was 95.6% (43/45) for physicians and 85.7% (24/28) for nurses. Even after adjusting for known covariates, our principal finding was that doctors reported greater psychological distress compared to nurses (p=0.009). Doctors also reported lower job satisfaction compared to nurses (p = 0.017), despite higher levels of patient-centredness found in nurses (p=0.001). Findings may be explained in part by differences in job characteristics and demands.

    CONCLUSIONS: Mental health is an important concern not just in cancer patients but among healthcare professionals in oncology.

  15. Idayu Mat Nawi R, Lei Chui P, Wan Ishak WZ, Hsien Chan CM
    Clin J Oncol Nurs, 2018 10 01;22(5):555-560.
    PMID: 30239519 DOI: 10.1188/18.CJON.555-560
    BACKGROUND: Evidence remains mixed on the benefits of oral cryotherapy in the prevention of oral mucositis and pain associated with fluorouracil-based chemotherapy.

    OBJECTIVES: The intent of this article is to evaluate the effect of oral cryotherapy on the prevention of oral mucositis and pain among patients with colorectal cancer undergoing fluorouracil-based chemotherapy.

    METHODS: Using an experimental study design, the authors randomly assigned 80 patients to either the intervention (n = 40) or usual care group (n = 40). Intervention group participants received oral cryotherapy in the form of ice chips held in their mouths during chemotherapy infusion. Both groups used sodium bicarbonate mouthwash postchemotherapy until the next cycle.

    FINDINGS: In the usual care group, most participants reported grade 2 (moderate to life-threatening) or greater mucositis. Pain associated with mucositis was lower using oral cryotherapy, with the majority of participants in the intervention group reporting no pain.

  16. Al Zamel LG, Abdullah KL, Chan CM, Piaw CY
    Florence Nightingale J Nurs, 2021 Jun;29(2):203-211.
    PMID: 34263239 DOI: 10.5152/FNJN.2021.20069
    AIM: This study aimed to investigate the moderating effect of demographic variables (sex, age, marital status, years of experience, level of education, and income) on the relationship between quality of work life and turnover intention in Malaysian nurses.

    METHOD: A descriptive, and cross-sectional design using Brook's quality of nursing work life questionnaire (self-reported) and Porter's anticipated turnover scale was implemented to collect data from 430 randomly selected Malaysian nurses in a teaching hospital's medical, surgical, and special units. The data were analyzed using the structural equation model smart partial least squares and Statistical Package for Social Sciences software services.

    RESULTS: The nurses had a moderate level of quality of work life and high level of turnover intention. Sex, number of children, and work wards/units had a moderating effect on turnover intention, after its interaction with quality of work life (p < .05).

    CONCLUSION: The study findings highlighted the factors having a moderating effect on turnover intention after its interaction with quality of work life . This knowledge is beneficial for providing guidance to nursing leaders or healthcare departments in hospitals to improve nurses' quality of work life and decrease their turnover intention. Addressing and understanding the demands and needs of nurses in the work environment and the family structure within a quality of work life could affect nurse's retention, leading to a decrease in their turnover intention.

  17. Rahman N'A, Chan CM, Zakaria MI, Jaafar MJ
    Australas Emerg Care, 2019 Mar;22(1):13-21.
    PMID: 30998867 DOI: 10.1016/j.auec.2018.11.002
    INTRODUCTION: An emergency department (ED) is often the first point of medical contact for sepsis patient, which plays an important role in early identification and management of high-risk septic patients. The present study was aim to evaluate emergency personnel's knowledge and attitude toward identification and management of systemic inflammatory response syndrome (SIRS) and sepsis.

    METHODS: This cross-sectional study was conducted in a tertiary teaching hospital and recruited all emergency personnel. A validated questionnaire on knowledge and attitude towards identification and management of SIRS/sepsis was distributed among 120 emergency personnel. Data were analyzed using descriptive and inferential statistics.

    RESULTS: Overall finding founds emergency nurses and assistant medical officer appeared to have moderate knowledge in several important areas of SIRS/sepsis identification and management. Majority of the emergency personnel have neutral attitudes, as they do not give enough importance towards identification of patients with SIRS and sepsis. The present study finding found that knowledge of clinical criteria and management of SIRS/sepsis was highest among assistant medical officers (p=0.02) and bachelor's degree holders (p=0.02) with emergency experience more than 5 years (p=0.03). A trend toward an increase in knowledge of SIRS and sepsis is significantly correlated with positive attitudes.

    CONCLUSION: The emergency personnel demonstrated a moderate knowledge and neutral attitude toward identification and management of SIRS and sepsis. Therefore, the awareness and knowledge of SIRS and sepsis should be enhanced among emergency personnel in order to improve outcome.

  18. Bamatraf AA, AlAmodi AA, Ali MA, Chan CM, Mazlan M, Shareef MA
    J Family Med Prim Care, 2020 Jun;9(6):2990-2994.
    PMID: 32984161 DOI: 10.4103/jfmpc.jfmpc_247_20
    Purpose: This study aims to investigate the level of strain and various influencing factors among informal care providers of traumatic brain injury (TBI) patients.

    Methods: A cross-sectional study was conducted in a single center in Malaysia via recruiting care providers of patients with TBI. The modified caregiver strain index (MCSI) questionnaires were utilized to ascertain the level of strain. The demographic data of informal care providers were also obtained. Independent sample t-test, analysis of variance (ANOVA), and a linear regression model were processed for data analysis.

    Results: A total of 140 informal care providers were included in the study. More than half of informal care providers claimed to have strain (54.3%). Factors associated with increased strain include receiving tertiary education, being of Chinese background, and employed experience higher strain level. Informal care providers with characteristics such as being single, retired and provided care for 5 years experienced a lower level of strain.

    Conclusion: Guidance on integrating the TBI knowledge into practice, assessing the care provider's level of strain regularly and providing supportive measures may aid in supporting informal care providers at risk.

  19. Tumin M, Tafran K, Mohd Satar NH, Peng NK, Manikam R, Yoong TL, et al.
    Exp Clin Transplant, 2019 02;17(1):1-5.
    PMID: 29766774 DOI: 10.6002/ect.2017.0214
    OBJECTIVES: This paper explores health care professionals' potential attitude toward organ donation if the presumed consent system were to be implemented in Malaysia, as well as factors associated with this attitude.

    MATERIALS AND METHODS: We used self-administered questionnaires to investigate the attitude of 382 health care professionals from the University of Malaya Medical Center between January and February 2014. The responses were analyzed using logistic regression.

    RESULTS: Of the 382 respondents, 175 (45.8%) stated that they would officially object to organ donation if the presumed consent system were to be implemented, whereas the remaining 207 (54.2%) stated that they would not object. The logistic regression showed that health care professionals from the Malay ethnic group were more likely to object than those from Chinese (adjusted odds ratio of 0.342; P = .001) and Indian and other (adjusted odds ratio of 0.341; P = .003) ethnic groups. Health care professionals earning 3000 Malaysian Ringgit or below were more likely to object than those earning above 3000 Malaysian Ringgit (adjusted odds ratio of 1.919; P = .006). Moreover, respondents who were initially unwilling to donate organs, regardless of the donation system, were more likely to object under the presumed consent system than those who were initially willing to donate (adjusted odds ratio of 2.765; P < .001).

    CONCLUSIONS: Health care professionals in Malaysia have a relatively negative attitude toward the presumed consent system, which does not encourage the implementation of this system in the country at present. To pave the way for a successful implementation of the presumed consent system, efforts should be initiated to enhance the attitude of health care professionals toward this system. In particular, these efforts should at most target the health care professionals who are Malay, earn a low income, and have a negative default attitude toward deceased donation.

  20. Chan CM, Wan Ahmad WA, Yusof MM, Ho GF, Krupat E
    Psychooncology, 2015 Jun;24(6):718-25.
    PMID: 25345781 DOI: 10.1002/pon.3714
    Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In this study, we examined the prevalence of psychiatric morbidity and its association with cancer survival over time.
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