Displaying publications 1 - 20 of 49 in total

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  1. Fulltext What influences patients' acceptance of a blood pressure telemonitoring service in primary care? A qualitative study
    Abdullah A, Liew SM, Hanafi NS, Ng CJ, Lai PS, Chia YC, et al.
    Patient Prefer Adherence, 2016;10:99-106.
    PMID: 26869773 DOI: 10.2147/PPA.S94687
    BACKGROUND: Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients' acceptance of such service in routine clinical care.
    OBJECTIVE: This study aimed to explore patients' acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM).
    METHODS: A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis.
    RESULTS: Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and suggested improvement to the BP telemonitoring functionalities to improve interactions. Patients cited being involved in research as the main reason for their intention to use the service. They felt that patients with limited experience with the internet and information technology, who worked out of town, or who had an outdoor hobby would not be able to benefit from such a service.
    CONCLUSION: Patients found BP telemonitoring service in primary care easy to use but needed help to interpret the meanings of monitored BP readings. Implementations of BP telemonitoring service must tackle these issues to maximize the patients' acceptance of a BP telemonitoring service.
  2. Views and experiences of Malaysian family medicine trainees of female sexual dysfunction
    Lai PS, Tan SY, Liew SM
    Arch Sex Behav, 2016 Nov;45(8):2081-2089.
    PMID: 27502351 DOI: 10.1007/s10508-016-0796-1
    Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.
  3. Fulltext Validation of the diabetes, hypertension and hyperlipidemia (DHL) knowledge instrument in Malaysia
    Lai PS, Chua SS, Tan CH, Chan SP
    BMC Med Res Methodol, 2012 Feb 24;12:18.
    PMID: 22361093 DOI: 10.1186/1471-2288-12-18
    BACKGROUND: Patient's knowledge on diabetes, hypertension and hyperlipidaemia and its medications can be used as one of the outcome measures to assess the effectiveness of educational intervention. To date, no such instrument has been validated in Malaysia. Therefore, the aim of this study was to evaluate the validity and reliability of the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument for assessing the knowledge of patients with type 2 diabetes in Malaysia.

    METHODS: A 28-item instrument which comprised of 5 domains: diabetes, hypertension, hyperlipidemia, medications and general issues was designed and tested. One point was given for every correct answer, whilst zero was given for incorrect answers. Scores ranged from 0 to 28, which were then converted into percentage. This was administered to 77 patients with type 2 diabetes in a tertiary hospital, who were on medication(s) for diabetes and who could understand English (patient group), and to 40 pharmacists (professional group). The DHL knowledge instrument was administered again to the patient group after one month. Excluded were patients less than 18 years old.

    RESULTS: Flesch reading ease was 60, which is satisfactory, while the mean difficulty factor(SD) was 0.74(0.21), indicating that DHL knowledge instrument was moderately easy. Internal consistency of the instrument was good, with Cronbach's α = 0.791. The test-retest scores showed no significant difference for 26 out of the 28 items, indicating that the questionnaire has achieved stable reliability. The overall mean(SD) knowledge scores was significantly different between the patient and professional groups [74.35(14.88) versus 93.84(6.47), p < 0.001]. This means that the DHL knowledge instrument could differentiate the knowledge levels of participants. The DHL knowledge instrument shows similar psychometric properties as other validated questionnaires.

    CONCLUSIONS: The DHL knowledge instrument shows good promise to be adopted as an instrument for assessing diabetic patients' knowledge concerning their disease conditions and medications in Malaysia.

  4. Validation of the Physician-Pharmacist Collaborative Index for physicians in Malaysia
    Sellappans R, Ng CJ, Lai PS
    Int J Clin Pharm, 2015 Dec;37(6):1242-9.
    PMID: 26408408 DOI: 10.1007/s11096-015-0200-6
    BACKGROUND: Establishing a collaborative working relationship between doctors and pharmacists is essential for the effective provision of pharmaceutical care. The Physician-Pharmacist Collaborative Index (PPCI) was developed to assess the professional exchanges between doctors and pharmacists. Two versions of the PPCI was developed: one for physicians and one for pharmacists. However, these instruments have not been validated in Malaysia.

    OBJECTIVE: To determine the validity and reliability of the PPCI for physicians in Malaysia.

    SETTING: An urban tertiary hospital in Malaysia.

    METHODS: This prospective study was conducted from June to August 2014. Doctors were grouped as either a "collaborator" or a "non-collaborator". Collaborators were doctors who regularly worked with one particular clinical pharmacist in their ward, while non-collaborators were doctors who interacted with any random pharmacist who answered the general pharmacy telephone line whenever they required assistance on medication-related enquiries, as they did not have a clinical pharmacist in their ward. Collaborators were firstly identified by the clinical pharmacist he/she worked with, then invited to participate in this study through email, as it was difficult to locate and approach them personally. Non-collaborators were sampled conveniently by approaching them in person as these doctors could be easily sampled from any wards without a clinical pharmacist. The PPCI for physicians was administered at baseline and 2 weeks later.

    MAIN OUTCOME MEASURE: Validity (face validity, factor analysis and discriminative validity) and reliability (internal consistency and test-retest) of the PPCI for physicians.

    RESULTS: A total of 116 doctors (18 collaborators and 98 non-collaborators) were recruited. Confirmatory factor analysis confirmed that the PPCI for physicians was a 3-factor model. The correlation of the mean domain scores ranged from 0.711 to 0.787. "Collaborators" had significantly higher scores compared to "non-collaborators" (81.4 ± 10.1 vs. 69.3 ± 12.1, p < 0.001). The Cronbach alpha for the overall PPCI for physicians was 0.949, while the Cronbach alpha values for the individual domains ranged from 0.877 to 0.926. Kappa values at test-retest ranged from 0.553 to 0.752.

    CONCLUSION: The PPCI for physicians was a valid and reliable measure in determining doctors' views about collaborative working relationship with pharmacists, in Malaysia.

  5. Validation of the Malay version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia
    Nagammai T, Mohazmi M, Liew SM, Chinna K, Lai PS
    Qual Life Res, 2015 Aug;24(8):2031-7.
    PMID: 25648757 DOI: 10.1007/s11136-015-0933-7
    PURPOSE: To assess the validity and reliability of the Malay version of the Quality of Life (QOL) Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia.
    METHODS: The QUALEFFO-41 was translated from English to Malay and administered to 215 post-menopausal osteoporotic women ≥50 years who could understand Malay, at baseline and 4 weeks. The SF-36 was administered at baseline to assess convergent validity. To assess discriminative validity, patients with and without back pain were recruited.
    RESULTS: Confirmatory factor analysis showed that the QUALEFFO-41 had five domains. Good internal consistency was seen in all domains (0.752-0.925) except for the social activity domain (0.692). Test-retest reliability showed adequate correlation for all items (0.752-0.964, p < 0.001). Patients with back pain had significantly worse QOL compared with those without (back pain = 42.2 ± 10.9, no back pain = 33.3 ± 8.9; p < 0.001). The total QUALEFFO-41 score and the SF-36 physical and mental composite scores were significantly correlated (-0.636 and -0.529, p < 0.001, respectively).
    CONCLUSIONS: The Malay version of the QUALEFFO-41 was found to be a reliable and valid instrument to evaluate the QOL of osteoporotic patients in Malaysia. To enable the QUALEFFO-41 to be used in a multiracial population, further studies should look into validating other versions of the QUALEFFO-41 in Malaysia.
  6. Fulltext Use of Post-Mortem Computed Tomography During the COVID-19 Pandemic: The Malaysian Experience
    Chainchel Singh MK, Mohd Noor MH, Ibrahim MA, Siew SF, Lai PS
    Malays J Med Sci, 2022 Oct;29(5):83-92.
    PMID: 36474535 DOI: 10.21315/mjms2022.29.5.9
    BACKGROUND: COVID-19 was declared a pandemic by the World Health Organization (WHO). COVID-19 is highly contagious, making it a threat to healthcare workers, including those working in mortuaries. Therefore, it is important to determine if the cause of death (COD) could be identified using limited autopsy, diagnostic tests and post-mortem imaging modalities instead of full autopsy. This study aims to examine the effectiveness of post-mortem imaging, specifically post-mortem computed tomography (PMCT) at determining the COD during a pandemic.

    METHODS: This cross-sectional study included 172 subjects with suspected or unknown COVID-19 status brought in dead to the institute's mortuary during the pandemic in Malaysia. PMCT images reported by forensic radiologists and their agreement with conventional autopsy findings by forensic pathologists regarding COD were analysed to look at the effectiveness of PMCT in determining COD during a pandemic.

    RESULTS: Analysis showed that 78.7% (133) of cases reported by forensic radiologists concurred with the COD certified by forensic pathologists. Of these cases, 85 (63.9%) had undergone only external examination and real-time reverse transcriptase polymerase chain reaction (rRT-PCR) COVID-19 testing, meaning that imaging was the sole method used to determine the COD besides history from available medical records and the investigating police officer.

    CONCLUSION: PMCT can be used as a complement to medicolegal autopsies in pandemic contexts, as it provides significant information on the possible COD without jeopardising the safety of mortuary health care workers.

  7. Fulltext Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors
    Lai PS, Wong YY, Low YC, Lau HL, Chin KF, Mahadeva S
    PeerJ, 2014;2:e451.
    PMID: 25024919 DOI: 10.7717/peerj.451
    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.
  8. Training in clinical genetics and genetic counseling in Asia
    Cutiongco-de la Paz EM, Chung BH, Faradz SMH, Thong MK, David-Padilla C, Lai PS, et al.
    Am J Med Genet C Semin Med Genet, 2019 06;181(2):177-186.
    PMID: 31037827 DOI: 10.1002/ajmg.c.31703
    The status of training in clinical genetics and genetic counseling in Asia is at diverse stages of development and maturity. Most of the training programs are in academic training centers where exposure to patients in the clinics or in the hospital is a major component. This setting provides trainees with knowledge and skills to be competent geneticists and genetic counselors in a variety of patient care interactions. Majority of the training programs combine clinical and research training which provide trainees a broad and integrated approach in the diagnosis and management of patients while providing opportunities for research discoveries that can be translated to better patient care. The background on how the training programs in clinical genetics and genetic counseling in Asia evolved to their current status are described. Each of these countries can learn from each other through sharing of best practices and resources.
  9. The validity and reliability of the Malaysian Osteoporosis Knowledge Tool in postmenopausal women
    Lai PS, Chua SS, Chan SP, Low WY
    Maturitas, 2008 Jun 20;60(2):122-30.
    PMID: 18508210 DOI: 10.1016/j.maturitas.2008.04.006
    OBJECTIVES: To design a valid and reliable questionnaire, the Malaysian Osteoporosis Knowledge Tool (MOKT), to assess the knowledge of postmenopausal osteoporotic women in Malaysia, on osteoporosis and its treatment.
    METHODS: A 40-item instrument was designed and tested in this study. The scores ranged from 1 to 40, which were then converted into percentage. This was administered to 88 postmenopausal osteoporotic women who were taking alendronate (patient group) and 43 pharmacists (professional group). The MOKT was administered again to the patient group after 1 month.
    RESULTS: Flesch reading ease was 57, which is satisfactory, while the mean difficulty factor+/-S.D. was 0.73+/-0.25, indicating that the MOKT is moderately easy. Internal consistency of the instrument was good with Cronbach's alpha=0.82. The test and retest scores showed no significant difference for 38 out of the 40 items, indicating that the questionnaire has achieved a stable reliability. Level of knowledge on osteoporosis and its treatment was good with a mean score+/-S.D. of 69.0+/-13.9 and 81.6+/-9.5 in the patient and professional group, respectively. The difference in knowledge scores between the two groups was statistically significant (p<0.001).
    CONCLUSIONS: In conclusion, the 40-item questionnaire (MOKT) is a reliable and valid instrument for measuring knowledge on osteoporosis in the Malaysian setting. Therefore, it can be used to identify individuals in need of educational interventions and to assess the effectiveness of education efforts as part of osteoporosis management.
  10. Fulltext The validity and reliability of the English version of the diabetes distress scale for type 2 diabetes patients in Malaysia
    Chin YW, Lai PS, Chia YC
    BMC Fam Pract, 2017 02 20;18(1):25.
    PMID: 28219325 DOI: 10.1186/s12875-017-0601-9
    BACKGROUND: Several disease specific instruments have been developed to identify and assess diabetes distress. In Malaysia, the Problem Areas in Diabetes Scale has been validated in Malay, but it does not have specific domains to assess the different areas of diabetes-related distress. Hence, we decided to use the Diabetes Distress Scale instead. To date, only the Malay version of the Diabetes Distress Scale has been validated in Malaysia. However, English is widely spoken by Malaysians, and is an important second language in Malaysia. Therefore, our aim was to determine the validity and reliability of the English version of the Diabetes Distress Scale among patients with type 2 diabetes in Malaysia.
    METHODS: The Diabetes Distress Scale was administered to 114 patients with type 2 diabetes, who could understand English, at baseline and 4 weeks later, at a primary care clinic in Malaysia. To assess for convergent validity, the Depression Anxiety Stress Scale was administered at baseline. Discriminative validity was assessed by analysing the total diabetes distress scores of participants with poor (HbA1c > 7.0%) and good glycaemic control (HbA1c ≤ 7.0%).
    RESULTS: The majority of our participants were male 65(57.0%), with a median duration of diabetes of 9.5 years. Exploratory factor analysis showed that the Diabetes Distress Scale had 4 subscales, as per the original Diabetes Distress Scale. The overall Cronbach's α was 0.920 (range = 0.784-0.859 for each subscale). The intraclass correlation ranged from 0.436 to 0.643 for test-retest. The Diabetes Distress Scale subscales were significantly correlated with the different subscales of the Depression Anxiety Stress Scale (spearman's rho range = 0.427-0.509, p 
  11. The use of jigsaw learning technique in teaching medical students prescribing skills
    Sim SM, Foong CC, Tan CH, Lai PS, Chua SS, Mohazmi M
    Med Teach, 2014 Feb;36(2):182.
    PMID: 24156275 DOI: 10.3109/0142159X.2013.848977
  12. The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia
    Siow JY, Lai PS, Chua SS, Chan SP
    Int J Pharm Pract, 2009 Oct;17(5):305-11.
    PMID: 20214273
    In recent years, the usage of activated vitamin D (alpha-calcidol and calcitriol) in the University Malaya Medical Centre (UMMC) has escalated and this has put unnecessary burden on the hospital's limited health care budget. The main aim of this study was to determine the effects of a clinical pharmacist's intervention in reducing the inappropriate use of activated vitamin D.
  13. The effect of mandatory generic substitution on the safety of alendronate and patients' adherence
    Lai PS, Chua SS, Chong YH, Chan SP
    Curr Med Res Opin, 2012 Aug;28(8):1347-55.
    PMID: 22746354 DOI: 10.1185/03007995.2012.708326
    Generic medicines are often used in public hospitals. However, data on the quality of generic alendronate, its efficacy, side-effects and medication adherence in clinical practice is scarce. Therefore, this study aimed to compare the side-effects and medication adherence of generic (apo-alendronate*) and proprietary alendronate (Fosamax†).
  14. Fulltext The development and validation of the advance care planning questionnaire in Malaysia
    Lai PS, Mohd Mudri S, Chinna K, Othman S
    BMC Med Ethics, 2016 10 18;17(1):61.
    PMID: 27756366
    BACKGROUND: Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia.

    METHODS: The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration.

    RESULTS: Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947.

    CONCLUSIONS: The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.
  15. Fulltext The development and validation of the Satisfaction Questionnaire for Osteoporosis Prevention in Malaysia
    Toh LS, Lai PS, Wu DB, Wong KT, Low BY, Tan AT, et al.
    Patient Prefer Adherence, 2014;8:1365-81.
    PMID: 25328386 DOI: 10.2147/PPA.S65718
    Purpose: To develop and validate the English version of the Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) in Malaysia.
    Methods: The SQOP was modified from the Osteoporosis Patient Satisfaction Questionnaire and developed based on literature review and patient interviews. Face and content validity were established via an expert panel. The SQOP consists of two sections: clinical services and types of counseling. There were 23 items in total, each with a five-point Likert-type response. Satisfaction score was calculated by converting the total score to a percentage. A higher score indicates higher satisfaction. English speaking, non-osteoporotic, postmenopausal women aged 50 years were included in the study. Participants were randomized to either the control or intervention group. Intervention participants were provided counseling, whereas control participants received none. Participants answered the SQOP at baseline and 2 weeks later.
    Results: A total of 140 participants were recruited (control group: n=70; intervention group: n=70). No significant differences were found in any demographic aspects. Exploratory factor analysis extracted seven domains. Cronbach’s α for the domains ranged from 0.531–0.812. All 23 items were highly correlated using Spearman’s correlation coefficient 0.469–0.996 (P<0.05), with no significant change in the control group’s overall test–retest scores, indicating that the
    SQOP achieved stable reliability. The intervention group had a higher score than the control group (87.91±5.99 versus 61.87±8.76; P<0.05), indicating that they were more satisfied than control participants. Flesch reading ease was 62.9.
    Conclusion: The SQOP was found to be a valid and reliable instrument for assessing patients’ satisfaction towards an osteoporosis screening and prevention service in Malaysia.
    Keywords: patient satisfaction, randomized controlled trial, postmenopausal women, screening
    Study site: primary care clinic, tertiary hospital, Malaysia
  16. Fulltext The development and validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia
    Toh LS, Lai PS, Wu DB, Wong KT, Low BY, Anderson C
    PLoS One, 2015;10(5):e0124553.
    PMID: 25938494 DOI: 10.1371/journal.pone.0124553
    Objectives: To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.
    Methods: The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women 50 years of age and pharmacists were included in the study.
    Results: A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean±SD accuracy rate was 0.60±0.22 (range: 0.26-0.94). The Cronbach’s α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman’s rho: 0.761-0.990, p<0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9±8.7vs63.6±17.4, p<0.001), indicating
    that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.
    Conclusion: The OPAAT was found to be a valid and reliable instrument for assessing patient’s knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.
    Study site:: Primary care clinic, tertiary hospital, Malaysia
  17. Fulltext The Malaysian Medication Adherence Scale (MALMAS): concurrent validity using a clinical measure among people with type 2 diabetes in Malaysia
    Chung WW, Chua SS, Lai PS, Morisky DE
    PLoS One, 2015;10(4):e0124275.
    PMID: 25909363 DOI: 10.1371/journal.pone.0124275
    Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C). Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565) and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412). The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715). Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032). The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37) of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.
  18. Fulltext Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes
    Liew SM, Lee PY, Hanafi NS, Ng CJ, Wong SS, Chia YC, et al.
    Diabetol Metab Syndr, 2014;6:53.
    PMID: 24782916 DOI: 10.1186/1758-5996-6-53
    BACKGROUND:The US Federal and Drug Administration (FDA) recently revised statin drug labels to include the information that increases in fasting serum glucose and glycated haemoglobin levels have been reported with the use of statins. Yet in a survey, 87% of the doctors stated that they had never or infrequently observed increases in glucose or HbA1c levels in patients on statin. In this study we would like to determine the association between the use of statins and glycaemic control in a retrospective cohort of patients with hypertension.
    METHODS: A retrospective review of 1060 medical records of patients with hypertension at a primary care clinic was conducted. These records were selected using systematic random sampling (1:4). Data on patient socio-demographic factors; clinical profile; investigation results and prescribed medications were collected. Independent t-test was used for continuous variables while Pearson's χ2 test was used for categorical variables. Logistic regression was done to adjust for confounders.
    RESULTS: 810 (76.4%) patients with hypertension were on statins, out of which 792 (97.8%) were taking simvastatin 10 mg or 20 mg daily. Analysis of the whole group regardless of diabetes status showed that the statin user group had higher HbA1c and fasting blood glucose values. The difference in HbA1c levels remained significant (adjusted OR = 1.290, p = 0.044, 95% CI 1.006, 1.654) after adjustment for diabetes, diabetic medication and fasting blood glucose. In the study population who had diabetes, statin users again had significantly higher HbA1c level compared to statin non-users. This difference remained significant (adjusted OR 1.208, p = 0.037, 95% CI 1.012, 1.441) after adjustment for age and diabetic medications.
    CONCLUSIONS:Stat ins use is associated with increased HbA1c levels among hypertensive patients and hypertensive patients with diabetes. Clinicians managing hypertensive patients on statins should consider monitoring the HbA1c level and ensure that those with diabetes have their hyperglycaemia kept under control.
    KEYWORDS: Diabetes mellitus; HbA1c; Hypertension; Statin
    Study site: primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  19. Fulltext Screening of dystrophin gene deletions in Malaysian patients with Duchenne muscular dystrophy
    Marini M, Salmi AA, Watihayati MS, SMardziah MD, Zahri MK, Hoh BP, et al.
    Med J Malaysia, 2008 Mar;63(1):31-4.
    PMID: 18935728 MyJurnal
    Duchenne Muscular Dystrophy (DMD) is an X-linked recessive genetic disorder characterized by rapidly progressive muscle weakness. The disease is caused by deletion, duplication or point mutation of the dystrophin gene, located on the X chromosome (Xp21). Deletion accounts for 60% of the mutations within the 79 exons of the dystrophin gene. Seven exons (43, 44, 45, 46, 49, 50, and 51) were found to be most commonly deleted among the Asian patients. To detect the frequency of deletion of these 7 exons in Malaysian DMD patients, we carried out a molecular genetic analysis in 20 Malaysian DMD patients. The mean age of initial presentation was 60 months (SD 32 months, range 5-120 months). Fourteen patients were found to have deletion of at least one of the seven exons. The remaining six patients did not show any deletion on the tested exons. Deletions of exons 49, 50 and 51 were the most frequent (71.43%) and appear to be the hot spots in our cohort of patients.
  20. Reprint of: Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters
    Khoo LS, Lai PS, Saidin MH, Noor Z, Mahmood MS
    Forensic Sci Int, 2018 Jul;288:242-255.
    PMID: 29783180 DOI: 10.1016/j.forsciint.2018.04.017
    Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.
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