Displaying publications 1 - 20 of 47 in total

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  1. Abdullah NL, Gunasekaran R, Mohd-Zin SW, Lim BH, Maniam P, Mohd-Salleh AS, et al.
    BMC Res Notes, 2018 Jul 16;11(1):475.
    PMID: 30012199 DOI: 10.1186/s13104-018-3593-1
    OBJECTIVES: The Neural Tube Defects Research Group of University of Malaya was approached to analyze a tablet named TELSE, which may have resulted in a baby born with central nervous system malformation at the University of Malaya Medical Centre. In this animal experimental study, we investigated the content of TELSE and exposure of its contents that resulted in failure of primary neurulation.

    RESULTS: Liquid Chromatography Tandem Mass spectrophotometry analysis of the TELSE tablet confirmed the presence of trimethoprim as the active compound. The TELSE tablet-treated females produced significant numbers of embryos with exencephaly (n = 8, 36.4%, *P 

  2. Ahmedy F, Ahmad Fauzi A, Engkasan JP
    PMID: 29844926 DOI: 10.1038/s41394-018-0074-7
    Introduction: Tachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells' criteria. However, tachycardia is not highly specific and commonly presents in many other conditions.

    Case presentation: A 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells' criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery.

    Discussion: Acute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells' criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

  3. Akhavan Hejazi SM, Mazlan M, Abdullah SJ, Engkasan JP
    Singapore Med J, 2015 Feb;56(2):116-9.
    PMID: 25715857
    INTRODUCTION: This study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients.

    METHODS: This was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale.

    RESULTS: This study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001).

    CONCLUSION: Post-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.
  4. Annaswamy TM, Rizzo JR, Schnappinger A, Morgenroth DC, Engkasan JP, Ilieva E, et al.
    Am J Phys Med Rehabil, 2022 Jul 01;101(7 Suppl 1):S40-S44.
    PMID: 33852491 DOI: 10.1097/PHM.0000000000001752
    Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.
  5. Arienti C, Kiekens C, Bettinsoli R, Engkasan JP, Frischknecht R, Gimigliano F, et al.
    Eur J Phys Rehabil Med, 2021 Apr;57(2):303-308.
    PMID: 33971699 DOI: 10.23736/S1973-9087.21.06877-5
    During its fourth year of existence, Cochrane Rehabilitation went on to promote evidence-informed health decision-making in rehabilitation. In 2020, the outbreak of the COVID-19 pandemic has made it necessary to alter priorities. In these challenging times, Cochrane Rehabilitation has firstly changed its internal organisation and established a new relevant project in line with pandemic needs: the REH-COVER (Rehabilitation - COVID-19 evidence-based response) action. The aim was to focus on the timely collection, review and dissemination of summarised and synthesised evidence relating to COVID-19 and rehabilitation. Cochrane Rehabilitation REH-COVER action has included in 2020 five main initiatives: 1) rapid living systematic reviews on rehabilitation and COVID-19; 2) interactive living evidence map on rehabilitation and COVID-19; 3) definition of the research topics on "rehabilitation and COVID-19" in collaboration with the World Health Organization (WHO) rehabilitation programme; 4) Cochrane Library special collection on Coronavirus (COVID-19) rehabilitation; and 5) collaboration with COVID-END for the topics "rehabilitation" and "disability." Furthermore, we are still carrying on five different special projects: Be4rehab; RCTRACK; definition of rehabilitation for research purposes; ebook project; and a prioritization exercise for Cochrane Reviews production. The Review Working Area continued to identify and "tag" the rehabilitation-relevant reviews published in the Cochrane library; the Publication Working Area went on to publish Cochrane Corners, working more closely with the Cochrane Review Groups (CRGs) and Cochrane Networks, particularly with Cochrane Musculoskeletal, Oral, Skin and Sensory Network; the Education Working Area, the most damaged in 2020, tried to continue performing educational activities such as workshops in different online meetings; the Methodology Working Area organized the third and fourth Cochrane Rehabilitation Methodological (CRM) meetings respectively in Milan and Orlando; the Communication Working Area spread rehabilitation evidences through different channels and translated the contents in different languages.
  6. Arienti C, Kiekens C, Bettinsoli R, Engkasan JP, Gimigliano F, Grubisic F, et al.
    Eur J Phys Rehabil Med, 2020 Feb;56(1):120-125.
    PMID: 32093464 DOI: 10.23736/S1973-9087.20.06188-2
    During its third year of existence, Cochrane Rehabilitation goals included to point out the main methodological issues in rehabilitation research, and to increase the Knowledge Translation activities. This has been performed through its committees and specific projects. In 2019, Cochrane Rehabilitation worked on five different special projects at different stages of development: 1) a collaboration with the World Health Organization to extract the best evidence for Rehabilitation (Be4rehab); 2) the development of a reporting checklist for Randomised Controlled Trials in rehabilitation (RCTRACK); 3) the definition of what is the rehabilitation for research purposes; 4) the ebook project; and 5) a prioritization exercise for Cochrane Reviews production. The Review Committee finalized the screening and "tagging" of all rehabilitation reviews in the Cochrane library; the Publication Committee increased the number of international journals with which publish Cochrane Corners; the Education Committee continued performing educational activities such as workshops in different meetings; the Methodology Committee performed the second Cochrane Rehabilitation Methodological Meeting and published many papers; the Communication Committee spread the rehabilitation evidence through different channels and translated the contents in different languages. The collaboration with several National and International Rehabilitation Scientific Societies, Universities, Hospitals, Research Centers and other organizations keeps on growing.
  7. Chan SC, Engkasan JP
    NeuroRehabilitation, 2024;54(1):167-169.
    PMID: 38277315 DOI: 10.3233/NRE-246001
    BACKGROUND: Stroke can lead to permanent and severe disability. Provision of information to stroke survivors and their carers could help them cope with consequences of stroke and aware of secondary prevention.

    OBJECTIVE: The aim of this Cochrane review was to assess the effects of active or passive information provision for stroke survivors or their carers.

    METHODS: The population addressed in this review included stroke survivors, their carers, or both. The intervention studied was provision of active or passive information compared to standard care or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision. The primary outcomes were knowledge about stroke and stroke services, and anxiety.

    CONCLUSIONS: The authors concluded that the active provision of information may improve stroke survivors stroke-related knowledge and quality of life. It may reduce the cases and symptoms of anxiety and probably depression. The effect of active information provision to carers and passive information provision is still unclear; however, passive information may worsen stroke patients' symptoms of anxiety and depression.

  8. Engkasan JP, Ng CJ, Low WY
    Spinal Cord, 2015 Feb;53(2):130-4.
    PMID: 25403504 DOI: 10.1038/sc.2014.199
    STUDY DESIGN: Qualitative study using individual in-depth interviews.

    OBJECTIVE: To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI).

    SETTING: Five public hospitals in Malaysia.

    METHODS: Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals.

    RESULTS: Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers.

    CONCLUSIONS: A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.
  9. Engkasan JP, Ng CJ, Low WY
    Spinal Cord, 2014 Feb;52(2):157-62.
    PMID: 24276416 DOI: 10.1038/sc.2013.145
    STUDY DESIGN: Qualitative study using individual in-depth interviews.
    OBJECTIVES: The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI).
    SETTING: Public hospitals in Malaysia.
    METHODS: Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses.
    RESULTS: The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method.
    CONCLUSION: The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options.
    Study design: Qualitative study using individual in-depth interviews.
  10. Engkasan JP, Sudin SS
    J Rehabil Med, 2013 Feb;45(2):141-4.
    PMID: 23053003 DOI: 10.2340/16501977-1074
    To describe the bowel programmes utilized by individuals with spinal cord injury; and to determine the association between the outcome of the bowel programmes and various interventions to facilitate defecation.
  11. Engkasan JP, Ehsan FM, Chung TY
    J Rehabil Med, 2012 Jan;44(1):19-23.
    PMID: 22124514 DOI: 10.2340/16501977-0904
    The aims of this study were to examine the ability of patients to return to driving cars and riding motorcycles after lower limb amputation, and to explore the factors that significantly affect such ability.
  12. Engkasan JP
    NeuroRehabilitation, 2019;45(1):135-136.
    PMID: 31403951 DOI: 10.3233/NRE-189008
    The aim of this commentary is to discuss in a rehabilitation perspective the recently published Cochrane Review "Vitamin D for the management of multiple sclerosis" by Jagannath et al. (2018)1 under the direct supervision of Cochrane Multiple Sclerosis and rare diseases of the CNS Group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.
  13. Engkasan JP, Ahmad-Fauzi A, Sabirin S, Chai CC, Abdul-Malek IZ, Liguori S, et al.
    Eur J Phys Rehabil Med, 2019 Jun;55(3):378-383.
    PMID: 30961345 DOI: 10.23736/S1973-9087.19.05792-7
    BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) serves as a framework for defining and categorizing health and functioning. ICF could be used to classify research outcomes in a systematic manner.

    AIM: The aim of this study was to classify the primary outcomes used in Cochrane Systematic Reviews (CSRs) into the ICF domains of functioning; to describe the differences in primary outcomes in reviews related to rehabilitation intervention and non-rehabilitation intervention; and to describe the trend of outcome selections according year of publication.

    DESIGN: Methodological paper.

    POPULATION: Adult stroke population.

    METHODS: We analyzed the primary outcomes used in the CSRs published by the Cochrane Stroke Review Group up to December 2017. The primary outcomes were extracted and classified into the ICF domains of functioning (body functions, body structures and activity and participation).

    RESULTS: One hundred and seventy-four papers with 216 primary outcomes were included in this analysis. Less than half (102/216, 47.2%) of the outcomes could be classified into the ICF domains of functioning. For the outcomes that could be classified into the ICF domains, the majority (72/102, 70.5%) were in the activity and participation domain, followed by body functions (26/102, 25.5%) and body structures (4/102, 4.0%). Of the outcomes that could not be classified into the ICF domains (N.=114), death (81/114, 71.1%) and recurrent stroke (21/114,18.4%) formed the majority of the outcome. There were 75 CSRs on rehabilitation related interventions; the majority of the outcomes (75/97, 77.3%) used in rehabilitation related CSRs could be classified into the ICF framework with more than half (49/75, 65.3%) in the activity and participation domain.

    CONCLUSIONS: The majority of the primary outcomes selected by the Cochrane Stroke Review Group in their CSRs could not be classified into the ICF domains of functioning. Death and recurrence of vascular events remains the major outcome of interest. In rehabilitation related interventions, activity and participation domain is the functioning domain most commonly used.

    CLINICAL REHABILITATION IMPACT: The systematic use of patients-centered ICF-based outcomes in CSRs could help the application of evidence in clinical decision making.

  14. Engkasan JP, Hasnan N, Mohd Yusuf Y, Abdul Latif L
    Am J Phys Med Rehabil, 2017 02;96(2 Suppl 1):S90-S92.
    PMID: 28059888 DOI: 10.1097/PHM.0000000000000598
  15. Engkasan JP, Stucki G, Ali S, Yusof YM, Hussain H, Latif LA
    J Rehabil Med, 2018 Apr 18;50(4):346-357.
    PMID: 29159419 DOI: 10.2340/16501977-2283
    In February 2017, the World Health Organization (WHO) launched its historic "Rehabilitation 2030: A Call for Action". Scaling up rehabilitation in health systems requires concerted action across all 6 components of WHO's Health Systems Framework. For rehabilitation, information about functioning is essential, as it is required for effective rehabilitation at all levels of the health system. What is missing is a countrywide demonstration project involving the implementation of a clinical quality management system for the continuous improvement of rehabilitation, both at the level of clinical care for individual patients and at the level of rehabilitation service provision. Consequently, the Department of Rehabilitation Medicine at the University of Malaya and University Malaya Medical Centre, together with the Cheras Rehabilitation Hospital of the Ministry of Health, and the Social Security Organisation (SOCSO) Rehabilitation Centre in Malacca, Malaysia, initiated a project to develop a Malaysian-wide clinical quality management system for rehabilitation (CQM-R Malaysia). The objective of this paper is to describe CQM-R Malaysia. First, a conceptual description of a CQM-R based on the International Classification of Functioning, Disability and Health (ICF) is set out. The methods, results and conclusions of a situation analysis conducted in January 2017 are then reported. Finally, the building blocks and implementation action plan developed for CQM-R Malaysia are presented.
  16. Engkasan JP
    NeuroRehabilitation, 2023;52(1):149-151.
    PMID: 36617764 DOI: 10.3233/NRE-228028
    BACKGROUND: Pressure ulcers may develop in people with impaired mobility, sensation, or cognition. Alternating pressure (active) air beds, overlays and mattresses are commonly used to prevent pressure ulcers.

    OBJECTIVE: This Cochrane Review aimed to determine the effects of alternating pressure (active) air beds, overlays or mattresses compared with any support surface in preventing pressure ulcers.

    METHODS: The population addressed was people at risk of and with existing pressure ulcers. Studies comparing alternating pressure (active) air surfaces with any beds, overlays or mattresses were included. The outcomes studied were pressure ulcer incidence, patient support-surface-associated comfort, adverse events, health-related quality of life and cost-effectiveness.

    RESULTS: There were 32 studies with a total of 9058 participants. There is low certainty evidence that alternating pressure (active) air surfaces compared with foam surfaces may reduce the incidence of pressure ulcers. It is uncertain whether there is a difference in the proportion of people developing new pressure ulcers between alternating pressure (active) air surfaces and reactive water-filled, fibre, air, gel or standard hospital surfaces.

    CONCLUSION: The use of alternating pressure (active) air surfaces may reduce the incidence of pressure ulcers compared to foam surfaces. However, it is uncertain if it is superior to reactive air surfaces, water surfaces and fiber surfaces in preventing pressure ulcers.

  17. Engkasan JP, Shun CL, Rathore FA
    J Pak Med Assoc, 2023 Oct;73(10):2123-2125.
    PMID: 37876089 DOI: 10.47391/JPMA.23-77
    Neurogenic bladder is one of the negative consequences following a spinal cord injury (SCI). SCI patients who have neurogenic bladder depend on alternative methods to drain urine from their bladder. These include indwelling catheters, reflex voiding , suprapubic tapping and intermittent catheterisation. This review summarizes evidence from the literature of five selected complications (renal failure, urinary tract infections, calculi, urethral stricture, and bladder cancer) that could result from use of the different bladder drainage methods. There is inconsistent evidence to support the superiority of intermittent over indwelling catheterisation on risk of renal impairment, urethral stricture, and renal calculi. Indwelling catheterisations are associated with higher risk of bladder calculi and cancer. Caution needs to be taken when interpreting this review, as many of its findings are from retrospective studies, and more than a decade old. Clinicians need to communicate the evidence to their patients when making the decision on method of bladder drainage.
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