MyMedR

Displaying publications 1 - 20 of 127 in total

Abstract:

Sort:

Fulltext Statins in heart failure: do we need another trial?

Bonsu KO, Kadirvelu A, Reidpath DD

Vasc Health Risk Manag, 2013;9:303-19.
PMID: 23807852 DOI: 10.2147/VHRM.S44499

Statins lower serum cholesterol and are employed for primary and secondary prevention of cardiovascular events. Clinical evidence from observational studies, retrospective data, and post hoc analyses of data from large statin trials in various cardiovascular conditions, as well as small scale randomized trials, suggest survival and other outcome benefits for heart failure. Two recent large randomized controlled trials, however, appear to suggest statins do not have beneficial effects in heart failure. In addition to lowering cholesterol, statins are believed to have many pleotropic effects which could possibly influence the pathophysiology of heart failure. Following the two large trials, evidence from recent studies appears to support the use of statins in heart failure. This review discusses the role of statins in the pathophysiology of heart failure, current evidence for statin use in heart failure, and suggests directions for future research.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan

Thatte U, Hussain S, de Rosas-Valera M, Malik MA

Value Health, 2009 Nov-Dec;12 Suppl 3:S18-25.
PMID: 20586975 DOI: 10.1111/j.1524-4733.2009.00622.x

This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices.

Matched MeSH terms: Evidence-Based Medicine/economics*
Fulltext A review of breast cancer research in Malaysia

Yip CH, Bhoo Pathy N, Teo SH

Med J Malaysia, 2014 Aug;69 Suppl A:8-22.
PMID: 25417947 MyJurnal

Four hundred and nineteen articles related to breast cancer were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred and fifty four articles were selected and reviewed on the basis of clinical relevance and future research implications. Overall, Malaysian women have poor survival from breast cancer and it is estimated that half of the deaths due to breast cancer could be prevented. Five-year survival in Malaysia was low and varies among different institutions even within the same disease stage, suggesting an inequity of access to optimal treatment or a lack of compliance to optimal treatment. Malaysian women have poor knowledge of the risk factors, symptoms and methods for early detection of breast cancer, leading to late presentation. Moreover, Malaysian women experience cancer fatalism, belief in alternative medicine, and lack of autonomy in decision making resulting in delays in seeking or avoidance of evidence-based medicine. There are ethnic differences in estrogen receptor status, HER2 overexpression and incidence of triple negative breast cancer which warrant further investigation. Malay women present with larger tumours and at later stages, and even after adjustment for these and other prognostic factors (stage, pathology and treatment), Malay women have a poorer survival. Although the factors responsible for these ethnic differences have not been elucidated, it is thought that pharmacogenomics, lifestyle factors (such as weight-gain, diet and exercise), and psychosocial factors (such as acceptance of 2nd or 3rd line chemotherapy) may be responsible for the difference in survival. Notably, survivorship studies show self-management programmes and exercise improve quality of life, highlighting the need to evaluate the psychosocial impact of breast cancer on Malaysian women, and to design culturally-, religiously- and linguistically-appropriate psycho-education programmes to help women cope with the disease and improve their quality of life. Research done in the Caucasian populations may not necessarily apply to local settings and it is important to embark on local studies particularly prevention, screening, diagnostic, prognostic, therapeutic and psychosocial research.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Beta-blockers for heart failure: an evidence based review answering practical therapeutic questions

Ong HT, Ong LM, Kow FP

Med J Malaysia, 2012 Feb;67(1):7-11.
PMID: 22582541 MyJurnal

Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3.125 mg carvedilol, 12.5 mg metoprolol succinate) and increased gradually over weeks. Treatment benefit appears proportional to magnitude of heart rate reduction and thus target dose should be the maximum tolerated for adequate bradycardia. Even in decompensated heart failure or those with coexisting bronchospasm, beta-blockers are not contraindicated although the dose may have to be reduced or withheld temporarily. The consistent trial data should reassure clinicians and encourage them to confidently initiate beta blockers in patients with systolic heart failure.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Managing congestive heart failure in a general hospital in Malaysia. Are we keeping pace with evidence?

Chin SP, Sapari S, How SH, Sim KH

Med J Malaysia, 2006 Aug;61(3):278-83.
PMID: 17240575 MyJurnal

Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Are doctors in the university-based primary care clinic more evidence-based?

Khoo EM, Teng CL, Wong KC

Med J Malaysia, 2004 Mar;59(1):129.
PMID: 15535352
Matched MeSH terms: Evidence-Based Medicine
Fulltext Primary care doctors' perceptions towards evidence-based medicine in Melaka State: a questionnaire study

Chan GC, Teng CL

Med J Malaysia, 2005 Jun;60(2):130-3.
PMID: 16114151

A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conclucted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.

Matched MeSH terms: Evidence-Based Medicine*
Fulltext Upper respiratory tract infections: to what extent is the management evidence-based?

Teng CL, Nurjahan MI, Hashim NA, Punithambigai P, Leong KC, Mihat O

Med J Malaysia, 2003 Jun;58(2):159-66.
PMID: 14569735 MyJurnal

Over a 2-week period, the management of upper respiratory tract infection by 24 medical officers and medical assistants in Seremban District was studied. Each practitioner recorded clinical data and prescription for twenty consecutive patients using a structured questionnaire. The extent to which the practitioners used "predictive features" (fever, absence of cough, cervical adenopathy, enlarged tonsils and exudates on tonsils) in clinical decision-making was analysed. The mean antibiotic prescription rate was 28.7% (95% CI: 24.6%, 33.0%). The antibiotic prescription rate of medical officers and medical assistants were similar. Five features were independently associated with antibiotic prescription (phlegm, fever, cervical adenopathy, red throat and tonsillar exudates). Antibiotics were prescribed for 22.1% of patients with 0-1 predictive features. High prescribers were 5 times more likely to prescribe antibiotics in this group of patients than low prescribers. To a large extent the clinical decision-making of practitioners in this study was evidence based. However, they were unduly influenced by purulent manifestation (phlegm) and redness of throat. The antibiotic prescription rate in these government health clinics is potentially reducible by means of educational intervention.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Current trends in the management of chronic obstructive pulmonary disease

Liam CK

Med J Malaysia, 2000 Jun;55(2):285-92; quiz 293.
PMID: 19839165
Matched MeSH terms: Evidence-Based Medicine*
Teaching of evidence-based medicine to medical undergraduates

Atiya AS

Med J Malaysia, 2002 Dec;57 Suppl E:105-8.
PMID: 12733204

Medical practice is changing, and the foundations of the paradigm shift lie in the development in research over the last four decades. Today, it is no longer adequate to treat a patient purely on clinical experience alone without a clear demonstration of evidence based on research, particularly the use of randomised controlled clinical trials. What is thought to be an effective mode of treatment currently may not necessarily hold true by the time medical students begin his/her medical practice. As a consequence, many medical schools worldwide are increasingly promoting evidence-based medicine (EBM) teaching in their medical curriculum along with problem-based learning (PBL). Teaching of EBM requires a paradigm shift in itself, as students must possess additional skills that are not traditionally part of medical training. These include the ability to acquire the skills in 'means of answering questions' than just 'knowing the answer to questions'. This paper aims to describe what EBM is and to highlight the formative experience of the teaching of EBM at the medical undergraduate level in the University of Malaya. Challenges and opportunities towards successful adoption of evidence-based practice are discussed.

Matched MeSH terms: Evidence-Based Medicine/education*
A Review of Coronary Artery Disease Research in Malaysia

Ang CS, Chan KM

Med J Malaysia, 2016 06;71(Suppl 1):42-57.
PMID: 27801387 MyJurnal

Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

Matched MeSH terms: Evidence-Based Medicine
Beta-blockers for heart failure: why you should use them more

Ong HT, Kow FP

J Fam Pract, 2011 Aug;60(8):472-7.
PMID: 21814642
Matched MeSH terms: Evidence-Based Medicine
What we really need to do to reduce cardiovascular events in hypertensive patients

Ong HT

J Fam Pract, 2007 Sep;56(9):727-34.
PMID: 17764644
Matched MeSH terms: Evidence-Based Medicine
Current status in decision making to treat acute type A dissection: limited versus extended repair

Velayudhan BV, Idhrees M, Matalanis G, Park KH, Tang D, Sfeir PM, et al.

J Cardiovasc Surg (Torino), 2020 Jun;61(3):285-291.
PMID: 32337940 DOI: 10.23736/S0021-9509.20.11397-1

Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with "downstream problems" support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection.

Matched MeSH terms: Evidence-Based Medicine
Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis

Seow D, Shimozono Y, Tengku Yusof TNB, Yasui Y, Massey A, Kennedy JG

Am J Sports Med, 2021 02;49(2):529-537.
PMID: 32427520 DOI: 10.1177/0363546520916729

BACKGROUND: Hamstring injuries are common and account for considerable time lost to play in athletes. Platelet-rich plasma has potential as a means to accelerate healing of these injuries.
PURPOSE: (1) To present the evidence of platelet-rich plasma injection in the treatment of hamstring injuries, (2) evaluate the "best-case scenario" in dichotomous outcomes, and (3) evaluate the "worst-case scenario" in dichotomous outcomes.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: Two authors systematically reviewed the PubMed, Embase, and Cochrane Library databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with any discrepancies resolved by mutual consensus. The level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine and the quality of evidence by the Coleman Methodology Score. Meta-analysis by fixed effects models was used if heterogeneity was low (I2 < 25%) and random effects models if heterogeneity was moderate to high (I2≥ 25%). P values

Matched MeSH terms: Evidence-Based Medicine
Do manual therapies help low back pain? A comparative effectiveness meta-analysis

Menke JM

Spine (Phila Pa 1976), 2014 Apr 1;39(7):E463-72.
PMID: 24480940 DOI: 10.1097/BRS.0000000000000230

STUDY DESIGN: Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain.
OBJECTIVE:
Determine relative effectiveness of spinal manipulation therapies (SMTs), medical management, physical therapies, and exercise for acute and chronic nonsurgical low back pain.
SUMMARY OF BACKGROUND DATA: Results of spinal manipulation treatments of nonsurgical low back pain are equivocal. Nearly 40 years of SMT studies were not informative.
METHODS: Studies were chosen on the basis of inclusion in prior evidence syntheses. Effect sizes were converted to standardized mean effect sizes and probabilities of recovery. Nested model comparisons isolated nonspecific from treatment effects. Aggregate data were tested for evidential support as compared with shams.
RESULTS: Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham's effectiveness. Most acute results were within 95% confidence bands of that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not.
CONCLUSION: Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations--features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.

Matched MeSH terms: Evidence-Based Medicine
Fulltext The product of outcome-based undergraduate medical education: competencies and readiness for internship

Lai NM, Ramesh JC

Singapore Med J, 2006 Dec;47(12):1053-62.
PMID: 17139402

INTRODUCTION: Outcome-based curriculum is adopted at the International Medical University (IMU), Malaysia, where specific learning objectives are laid out progressively under eight major outcomes. We present an outcome-guided, self-reported competency profile of our undergraduate students near the end of their training, focusing on elements that are considered most immediately relevant for their internship.
METHODS: Anonymous surveys were conducted on two cohorts of medical students in their final semester at IMU. The surveys covered a range of competencies, including practical skills, ward routines, generic attributes and evidence-based medicine, grouped under the exit outcomes as defined by the university.
RESULTS: A total of 92 students were assessed. In general, the students were confident of their ability on common practical skills and ward routines. They were comfortable with the level of professionalism and personal attributes required for internship, with the prospect of handling unexpected additional tasks and working away from home perceived as the main difficulties. Most students referred to at least three sources of clinical information to answer their clinical queries. However, they referred more to single journals than databases or collections. The majority could critically appraise journal articles to a variable extent, but nearly half took 30 minutes or longer to trace an abstract of interest.
CONCLUSION: This report demonstrates the strength of outcome-based curriculum in its ability to produce competent students that are well prepared for their internship. Assessing students using this educational approach provides a clear picture of their strengths and weaknesses, and identifies stages in their training where additional inputs are required.

Matched MeSH terms: Evidence-Based Medicine
Writing a systematic review

Ng KH, Peh WC

Singapore Med J, 2010 May;51(5):362-6.
PMID: 20593139

Evidence-based medicine (EBM) aims to combine the best available scientific evidence with clinical experience and individual judgment of patient needs. In the hierarchy of scientific evidence, systematic reviews (along with meta-analyses) occupy the highest levels in terms of the quality of evidence. A systematic review is the process of searching, selecting, appraising, synthesising and reporting clinical evidence on a particular question or topic. It is currently considered the best, least biased and most rational way to organise, gather, evaluate and integrate scientific evidence from the rapidly-changing medical and healthcare literature. Systematic reviews could be used to present current concepts or serve as review articles and replace the traditional expert opinion or narrative review. This article explains the structure and content of a systematic review.

Matched MeSH terms: Evidence-Based Medicine*
Fulltext The effectiveness of FES-evoked EMG potentials to assess muscle force and fatigue in individuals with spinal cord injury

Ibitoye MO, Estigoni EH, Hamzaid NA, Wahab AK, Davis GM

Sensors (Basel), 2014;14(7):12598-622.
PMID: 25025551 DOI: 10.3390/s140712598

The evoked electromyographic signal (eEMG) potential is the standard index used to monitor both electrical changes within the motor unit during muscular activity and the electrical patterns during evoked contraction. However, technical and physiological limitations often preclude the acquisition and analysis of the signal especially during functional electrical stimulation (FES)-evoked contractions. Hence, an accurate quantification of the relationship between the eEMG potential and FES-evoked muscle response remains elusive and continues to attract the attention of researchers due to its potential application in the fields of biomechanics, muscle physiology, and rehabilitation science. We conducted a systematic review to examine the effectiveness of eEMG potentials to assess muscle force and fatigue, particularly as a biofeedback descriptor of FES-evoked contractions in individuals with spinal cord injury. At the outset, 2867 citations were identified and, finally, fifty-nine trials met the inclusion criteria. Four hypotheses were proposed and evaluated to inform this review. The results showed that eEMG is effective at quantifying muscle force and fatigue during isometric contraction, but may not be effective during dynamic contractions including cycling and stepping. Positive correlation of up to r = 0.90 (p < 0.05) between the decline in the peak-to-peak amplitude of the eEMG and the decline in the force output during fatiguing isometric contractions has been reported. In the available prediction models, the performance index of the eEMG signal to estimate the generated muscle force ranged from 3.8% to 34% for 18 s to 70 s ahead of the actual muscle force generation. The strength and inherent limitations of the eEMG signal to assess muscle force and fatigue were evident from our findings with implications in clinical management of spinal cord injury (SCI) population.

Matched MeSH terms: Evidence-Based Medicine
[Cancer pain management: Systematic review and critical appraisal of clinical practice guidelines]

Martínez-Nicolás I, Ángel-García D, Saturno PJ, López-Soriano F

Rev Calid Asist, 2016 Jan-Feb;31(1):55-63.
PMID: 26420516 DOI: 10.1016/j.cali.2015.06.009

OBJECTIVE: Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue.

MATERIALS AND METHODS: A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness.

RESULTS: Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one.

CONCLUSIONS: The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve.

Matched MeSH terms: Evidence-Based Medicine

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links