Displaying publications 1 - 20 of 36 in total

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  1. Vythilingam I, Tan SB, Krishnasamy M
    Trop Med Int Health, 2002 Jun;7(6):539-40.
    PMID: 12031077
    The susceptibility of Culex sitiens to Japanese Encephalitis (JE) virus was examined in the laboratory. Cx. sitiens became infected with JE virus on day 8 and subsequently it is able to transmit the virus when it takes a blood meal. Both parts of the experiment were carried out using artificial membrane feeding technique.
  2. Nazni WA, Luke H, Wan Rozita WM, Abdullah AG, Sa'diyah I, Azahari AH, et al.
    Trop Biomed, 2005 Jun;22(1):53-61.
    PMID: 16880754
    In order to control any pest it is essential to study the life cycle, biology and bionomics of the target pest under control. With this respect, we have studied the flight range of the house fly Musca domestica (L.). The flight range of the house fly from two sites i.e, the poultry farm and a stable farm has been studied. The flight range study was conducted using a mark release technique. The approach we used in this study was that the flies collected from the respective farms were marked and released at different distances from the farms. The flies were then re-captured from the poultry farm and the stable farm. Studies conducted elsewhere use the technique of releasing the insect species at one spot and recapturing the insect species with the help of baited traps placed at various locations from the release point. The advantage of the approach used in this study was that the flight range as well as the homing effect was determined. From this study, the flight range of house flies released at the poultry farm was 7 km whereas flight range for flies release from stable farm was 5 km. The recovery rate of house flies at the poultry and stable farm was 0.05% and 0.016%, In this study, marked specimens has been detected up to 8 days in field conditions indicating that under field condition the life expectancy could be in the range of 1-2 weeks.
  3. Tan SB, Ching HC, Chia YL, Yee A, Ng CG, Hasan MSB, et al.
    Am J Hosp Palliat Care, 2020 Aug;37(8):606-612.
    PMID: 31854193 DOI: 10.1177/1049909119894507
    Informal caregivers are at risk of being overwhelmed by various sources of suffering while caring for their significant others. It is, therefore, important for caregivers to take care of themselves. In the self-care context, mindfulness has the potential to reduce caregiver suffering. We studied the effect of a single session of 20-minute mindful breathing on the perceived level of suffering, together with the changes in bispectral index score (BIS) among palliative care informal caregivers. This was a randomized controlled study conducted at the University of Malaya Medical Centre, Malaysia. Forty adult palliative care informal caregivers were recruited and randomly assigned to either 20-minute mindful breathing or 20-minute supportive listening. The changes in perceived suffering and BIS were measured preintervention and postintervention. The reduction in suffering score in the intervention group was significantly more than the control group at minute 20 (U = 124.0, n1 = n2 = 20, mean rank1 = 24.30, mean rank2 = 16.70, z = -2.095, P = .036). The reduction in BIS in the intervention group was also significantly greater than the control group at minute 20 (U = 19.5, n1 = n2 = 20, mean rank1 = 29.52, mean rank2 = 11.48, z = -4.900, P < .0001). Twenty minutes of mindful breathing was more efficacious than 20 minutes of supportive listening in the reduction in suffering among palliative care informal caregivers.
  4. Ng DL, Chai CS, Tan KL, Chee KH, Tung YZ, Wai SY, et al.
    Am J Hosp Palliat Care, 2021 Mar;38(3):246-252.
    PMID: 32588653 DOI: 10.1177/1049909120934743
    Heart failure is the leading cause of morbidity and mortality worldwide. Standard treatment for heart failure includes pharmacotherapy and cardiac device implants. However, supportive approaches in managing dyspnea in heart failure are limited. This study aimed to test the efficacy of 20-minute mindful breathing in reducing dyspnea among patients admitted for acute decompensated heart failure. We conducted a parallel-group, non-blinded, randomized controlled trial of a single session of 20-minute mindful breathing plus standard care versus standard care alone among patients admitted for moderate to severe dyspnea due to acute decompensated heart failure, using the dyspnea score based on the Edmonton Symptom Assessment System (ESAS), at the Cardiology Unit of University Malaya Medical Centre in Malaysia. Thirty participants were randomly assigned to a single session of 20-minute mindful breathing plus standard care (n = 15) or standard care alone (n = 15), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the intervention group compared to the control group at minute 20 (U = 49.5, n1 = 15, n2 =15, median reduction in ESAS dyspnea score 1 = 2, median reduction in ESAS dyspnea score 2 = 0, mean rank 1 = 11.30, mean rank 2 = 19.70, z = -2.692, r = 0.4, P = 0.007). Our results provided evidence that a single session of 20-minute mindful breathing was efficacious in reducing dyspnea for patients admitted for acute decompensated heart failure.
  5. Ng DL, Bin Jamalludin MA, Gan XY, Ng SY, Bin Mohamad Rasidin MZ, Felix BA, et al.
    Risk Manag Healthc Policy, 2023;16:2505-2519.
    PMID: 38024502 DOI: 10.2147/RMHP.S439530
    INTRODUCTION: Malaysia entered the transition to the endemic phase of Coronavirus 2019 (COVID-19) on 1st April 2022. This study aims to determine the public's willingness to perform COVID-19 self-testing. Factors that influenced their willingness were also assessed.

    METHODS: A nationwide, cross-sectional, and population-based study was conducted online in Malaysia from 28th April 2023 to 4th June 2023. Individuals aged 18 years and above were enrolled through the snowball sampling method. Data were analyzed by using the Chi-Square test, independent t-test, and binary logistic regression.

    RESULTS: One thousand four hundred fifty-three responses were included in the analysis. Of these respondents, 89.3% were willing, 4.1% were reluctant, and 6.6% remained hesitant to perform COVID-19 self-testing, The common reasons given by those willing to perform COVID-19 self-testing included being able to self-isolate (99.0%) and seek treatment (96.3%) earlier if tested positive. The common reasons against COVID-19 self-testing included the belief that COVID-19 is equivalent to the common flu (91.7%) and having received the COVID-19 vaccine (78.3%). The isolation policy for COVID-19 was the most significant consideration for those who were still hesitant (85.4%). Women [adjusted odds ratios (OR): 2.1, 95% confidence intervals (95% CI): 1.44-3.00, p < 0.001], individuals with tertiary education (OR: 2.1, 95% CI: 1.32-3.26, p = 0.002), those vaccinated against COVID-19 (OR: 8.1, 95% CI: 2.63-24.82, p < 0.001), and individuals with prior experience of COVID-19 self-testing (OR: 4.2, 95% CI: 2.84-6.12, p < 0.001) showed a significantly higher willingness to engage in COVID-19 self-testing.

    CONCLUSION: The public exhibited a high willingness to perform COVID-19 self-testing during the transition to the endemic phase in Malaysia. Future strategies to promote COVID-19 self-testing uptake in Malaysia should focus on vulnerable groups, address the common concerns among those hesitant and reluctant, and highlight the advantages of COVID-19 self-testing.

  6. Chow PK, Poon DY, Khin MW, Singh H, Han HS, Goh AS, et al.
    PLoS One, 2014;9(3):e90909.
    PMID: 24614178 DOI: 10.1371/journal.pone.0090909
    The safety and tolerability of sequential radioembolization-sorafenib therapy is unknown. An open-label, single arm, investigator-initiated Phase II study (NCT0071279) was conducted at four Asia-Pacific centers to evaluate the safety and efficacy of sequential radioembolization-sorafenib in patients with hepatocellular carcinoma (HCC) not amenable to curative therapies.
  7. Wee SL, Tan SB, Jürgens A
    Phytochemistry, 2018 Sep;153:120-128.
    PMID: 29906658 DOI: 10.1016/j.phytochem.2018.06.005
    The plants of the enigmatic genus Rafflesia are well known for their gigantic flowers and their floral features such as pungent floral scent and vivid dark color, which mimics the food/brood sites of carrion. However, information on the pollination biology of this plant group remains limited and mostly anecdotal. In the present paper, we studied the floral volatiles of R. cantleyi Solms-Laubach and their role in pollinator attraction. To achieve these aims, the floral scent was collected in situ in the field using a dynamic headspace method followed by chemical analysis via GC-MS. The olfactory preferences of pollinators to the identified chemical compounds, were tested singly and in blends, in flight tunnel bioassays and compared with responses to headspace floral extracts. In addition, flower-visiting calliphorid flies and the local carrion fly community were sampled and identified. Five species of calliphorid flies (subfamilies of Chrysomyinae and Calliphorinae), all females, were found on the flowers, whereas nine species were found in the traps that were baited with tainted meat in the surrounding habitat. However, only flower visitors of one blow fly species, Chrysomya chani Kurahashi, were observed to carry R. cantleyi pollen after visiting male flowers. The floral volatiles emitted by male flowers in full bloom were dominated by two sulphur-containing compounds, dimethyl disulfide (DMDS) and dimethyl trisulfide (DMTS). These were accompanied by other minor compounds such as benzenoids (4), monoterpenoids (4), trace amounts of aliphatic compounds (1), and sesquiterpenes (1). In flight-tunnel bioassays, a female-specific positive response of C. chani flies to individual DMDS, DMTS, and a blend of DMDS and DMTS was evident. Our findings suggest that R. cantleyi biochemically mimics carrion and that relative ratio of oligosulfides in the floral scent play a key role in sex-biased pollinator specialization, attracting only female C. chani carrion flies to the flowers.
  8. Tan BK, Tan SB, Chen LC, Chang KM, Chua SS, Balashanker S, et al.
    Patient Prefer Adherence, 2017;11:1027-1034.
    PMID: 28652712 DOI: 10.2147/PPA.S132894
    PURPOSE: Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients' adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.

    PATIENTS AND METHODS: Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.

    RESULTS: Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.

    CONCLUSION: Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients' concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients' outcome.

    Study site: hematology outpatient clinics of Ampang Hospital (AH) and University Malaya Medical Centre (UMMC) in Malaysia
  9. Ng DL, Gan GG, Chai CS, Chee KH, Tan KL, Tan SB, et al.
    Patient Prefer Adherence, 2019;13:1363-1373.
    PMID: 31616136 DOI: 10.2147/PPA.S204246
    Introduction and aim: Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC).

    Methods: This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2).

    Results: A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069).

    Conclusion: Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.

  10. Ho JFV, Yaakup H, Low GSH, Wong SL, Tho LM, Tan SB
    Palliat Med, 2020 05;34(5):619-629.
    PMID: 32103707 DOI: 10.1177/0269216320904905
    BACKGROUND: The prevalence of undertreated cancer pain remains high. Suboptimal pain control affects quality of life and results in psychological and emotional distress. Barriers to adequate pain control include fear of opioid dependence and its side effects.

    AIM: To investigate the attitudes and perceptions of morphine use in cancer pain in advanced cancer patients and their caregivers and to examine the influence of caregivers' attitudes and perceptions on patients' acceptance of morphine.

    DESIGN: Qualitative study involving semi-structured individual interviews transcribed verbatim and analyzed thematically.

    SETTING/PARTICIPANTS: A total of 18 adult opioid-naïve patients with advanced cancer and 13 caregivers (n = 31) were recruited at a private tertiary hospital via convenience sampling.

    RESULTS: Attitudes and perceptions of morphine were influenced by previous experiences. Prevalent themes were similar in both groups, including perceptions that morphine was a strong analgesic that reduced suffering, but associated with end-stage illness and dependence. Most participants were open to future morphine use for comfort and effective pain control. Trust in doctors' recommendations was also an important factor. However, many preferred morphine as a last resort because of concerns about side effects and dependence, and the perception that morphine was only used at the terminal stage. Caregivers' attitudes toward morphine did not affect patients' acceptance of morphine use.

    CONCLUSION: Most participants were open to future morphine use despite negative perceptions as they prioritized optimal pain control and reduction of suffering. Focused education programs addressing morphine misperceptions might increase patient and caregiver acceptance of opioid analgesics and improve cancer pain control.

  11. Tan SB, Tan TT, Tan MP, Loo KK, Lim PK, Ng CG, et al.
    Omega (Westport), 2020 Jul 14.
    PMID: 32664784 DOI: 10.1177/0030222820942642
    To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.
  12. Choo XY, Lim SY, Chinna K, Tan YJ, Yong VW, Lim JL, et al.
    Neurol Sci, 2020 Oct;41(10):2831-2842.
    PMID: 32314118 DOI: 10.1007/s10072-020-04396-4
    INTRODUCTION: Little is known regarding the educational needs and perspectives of people living with Parkinson's disease (PD), particularly in Asia.

    OBJECTIVE: To assess knowledge and perceptions regarding PD in a large multiethnic urban Asian cohort of patients and caregivers.

    METHODS: We conducted a survey at a university hospital neurology clinic, using a novel Knowledge and Perception of Parkinson's Disease Questionnaire (KPPDQ).

    RESULTS: The KPPDQ had satisfactory psychometric properties among patients and caregivers. Five hundred subjects were recruited with a 97% response rate (211 patients, 273 caregivers). Non-motor symptoms such as urinary problems, visual hallucinations and pain were relatively poorly recognized. Many (≈ 50-80%) respondents incorrectly believed that all PD patients experience tremor, that PD is usually familial, and that there is a cure for PD. About one-half perceived PD to be caused by something the patient had done in the past, and that PD medications were likely to cause internal organ damage. Issues of stigma/shame were relevant to one-third of patients, and 70% of patients perceived themselves to be a burden to others. Two-thirds of participants felt that PD imposed a heavy financial toll. Participants were about equally divided as to whether they would consider treatment with deep brain stimulation, tube feeding or invasive ventilation. Over three-quarters of patients expressed a preference to die at home.

    CONCLUSIONS: Important knowledge gaps, misperceptions and perspectives on PD were identified, highlighting the need for further efforts to raise awareness and provide accurate information regarding PD, and to address patient's and caregivers' needs and preferences.

  13. Kadravello A, Tan SB, Ho GF, Kaur R, Yip CH
    Medicina (Kaunas), 2021 Jul 07;57(7).
    PMID: 34356974 DOI: 10.3390/medicina57070693
    Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.
  14. Teh CH, Nazni WA, Lee HL, Fairuz A, Tan SB, Sofian-Azirun M
    Med Vet Entomol, 2013 Dec;27(4):414-20.
    PMID: 23650928 DOI: 10.1111/mve.12012
    The emergence of multidrug-resistant bacterial strains has prompted the reintroduction of maggot therapy in the treatment of chronic, infected wounds. Many previous studies have demonstrated the potent antibacterial activity of larval excretions/secretions of the blowfly Lucilia sericata (Meigen) (Diptera:Calliphoridae) against bacteria. However, the antibacterial activity of its sibling species, Lucilia cuprina (Wiedemann) (Diptera:Calliphoridae) against a wide range of pathogenic bacteria has never been determined. The aim of this study was to develop a new procedure to produce whole body extract of larvae of L. cuprina via methanol extraction as well as to demonstrate the in vitro antibacterial activity of this extract against seven selected wound pathogens (Staphylococcus aureus, methicillin-resistant S. aureus, S. epidermidis, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli). The turbidimetric assay demonstrated that L. cuprina larval extract was significantly potent against all bacteria tested (P 
  15. Wee SL, Tan SB, Tan SH, Lee BKB
    J Plant Res, 2024 Feb 14.
    PMID: 38353931 DOI: 10.1007/s10265-024-01522-7
    Despite being the world's largest single-flower, Rafflesia's biology and life history are still poorly understood due to its cryptic growth strategy on Tetrastigma vines. Previous studies have been mostly short-term, contrary to Rafflesia's long development period before blooming. Bud development and flower phenology of R. cantleyi was studied in a dipterocarp forest in Lata Jarum, Peninsular Malaysia. Seven populations, consisting of 247 buds, were monitored fortnightly for 65 months in two discrete studies between 2009 and 2018. The bud size distribution of R. cantleyi is dynamic, progressively changing from small flower buds to larger buds before flowering. Buds  15.0 cm across demonstrated accelerated growth. The bud growth profiles of the same site clustered distinctively regardless of sex with successful blooming rate that varied greatly between sites, prompting speculation about their relatedness to the sites' physical attributes. We reported the first female-dominated population in Rafflesia's life history. Rafflesia cantleyi's blooming rate at Lata Jarum is moderate to high, with non-seasonal flowering phenology as evident by the lack of synchronisation and consistency between flowering and local rainfall patterns. Based on the field data of the present study and the published information of other Rafflesia species, R. cantleyi's life cycle was estimated between 4.0 and 5.3 years. Our findings further explain Rafflesia's biology and life history and highlight the gap in knowledge of the natural habitats on the endoparasite's growth and fate potentially for future conservation and study.
  16. Ng CG, Lai KT, Tan SB, Sulaiman AH, Zainal NZ
    J Palliat Med, 2016 09;19(9):917-24.
    PMID: 27110900 DOI: 10.1089/jpm.2016.0046
    BACKGROUND: Palliative cancer patients suffer from high levels of distress. There are physiological changes in relation to the level of perceived distress.

    OBJECTIVE: To study the efficacy of 5 minutes of mindful breathing (MB) for rapid reduction of distress in a palliative setting. Its effect to the physiological changes of the palliative cancer patients was also examined.

    METHODS: This is a randomized controlled trial. Sixty palliative cancer patients were recruited. They were randomly assigned to either 5 minutes of MB or normal listening arms. The changes of perceived distress, blood pressure, pulse rate, breathing rate, galvanic skin response, and skin surface temperature of the patients were measured at baseline, after intervention, and 10 minutes post-intervention.

    RESULTS: There was significant reduction of perceived distress, blood pressure, pulse rate, breathing rate, and galvanic skin response; also, significant increment of skin surface temperature in the 5-minute MB group. The changes in the 5-minute breathing group were significantly higher than the normal listening group.

    CONCLUSION: Five-minute MB is a quick, easy to administer, and effective therapy for rapid reduction of distress in palliative setting. There is a need for future study to establish the long-term efficacy of the therapy.

  17. Tan SB, Liam CK, Pang YK, Leh-Ching Ng D, Wong TS, Wei-Shen Khoo K, et al.
    J Pain Symptom Manage, 2019 04;57(4):802-808.
    PMID: 30684635 DOI: 10.1016/j.jpainsymman.2019.01.009
    CONTEXT: Dyspnea is a common and distressing symptom in respiratory diseases. Despite advances in the treatment of various lung diseases, the treatment modalities for dyspnea remain limited.

    OBJECTIVES: This study aims to examine the effect of 20-minute mindful breathing on the rapid reduction of dyspnea at rest in patients with lung cancer, chronic obstructive pulmonary disease, and asthma.

    METHODS: We conducted a parallel-group, nonblinded, randomized controlled trial of standard care plus 20-minute mindful breathing vs. standard care alone for patients with moderate to severe dyspnea due to lung disease, named previously, at the respiratory unit of University Malaya Medical Centre in Malaysia, from August 1, 2017, to March 31, 2018.

    RESULTS: Sixty-three participants were randomly assigned to standard care plus a 20-minute mindful breathing session (n = 32) or standard care alone (n = 31), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the mindful breathing group compared with the control group at minute 5 (U = 233.5, n1 = 32, n2 = 31, mean rank1 = 23.28, mean rank2 = 37.72, z = -3.574, P 

  18. Tan SB, Lee YL, Tan SN, Ng TY, Teo YT, Lim PK, et al.
    J Hosp Palliat Nurs, 2020 10;22(5):407-414.
    PMID: 32898385 DOI: 10.1097/NJH.0000000000000678
    Palliative care providers find meaning in their work, even though stress, burnout, and compassion fatigue can be a concern. In this study, we aimed to explore the experiences of well-being of palliative care providers in Malaysia. Data collected using semistructured interviews were thematically analyzed. Eighteen palliative care providers participated: 9 doctors and 9 nurses. Five subthemes were generated: (1) values and strengths, (2) coping and work-life balance, (3) social support and spirituality, (4) passion and satisfaction, and (5) learning, growth, and transformation. These subthemes were further categorized into 2 themes: resilience and reward. The results may inform the development of interventions in the promotion and sustenance of well-being of palliative care providers.
  19. Yang Y, Østbye T, Tan SB, Abdul Salam ZH, Ong BC, Yang KS
    J Diabetes Complications, 2011 Nov-Dec;25(6):382-6.
    PMID: 21983153 DOI: 10.1016/j.jdiacomp.2011.08.002
    BACKGROUND:
    Among other risk factors, renal disease and ethnicity have been associated with diabetic lower extremity amputation (LEA) in Western populations. However, little is known about risk factors for LEA among Asian patients.

    OBJECTIVE:
    The objective was to assess the proportion of hospitalized patients with diabetes who have a LEA among all hospital patients with diabetes mellitus (DM) and to investigate risk factors for diabetic LEA (especially renal disease and ethnicity) using hospital discharge database.

    METHOD:
    A retrospective study of hospital discharge database (2004-2009) was performed to identify patients with DM, LEA and renal disease using the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision, Australian Modification codes.

    RESULTS:
    Of 44 917 hospitalized patients with DM during the 6 years, 7312 (16.3%) patients had renal disease, and 1457 (3.2%) patients had LEA. DM patients with renal disease had significant higher rates of LEA (7.1%) compared to DM patients without renal disease (2.5%, P < .001). The differences were present for foot (2.7% vs. 1.2%), ankle or leg (2.8% vs. 0.9%), and knee or above amputation (1.6% vs. 0.4%, all P
  20. Chow PKH, Gandhi M, Tan SB, Khin MW, Khasbazar A, Ong J, et al.
    J Clin Oncol, 2018 07 01;36(19):1913-1921.
    PMID: 29498924 DOI: 10.1200/JCO.2017.76.0892
    Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.
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