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  1. Fulltext Prevalence and clinical characteristics of Metabolic Syndrome among Malaysian Hypertensive subjects using the International Diabetes Federation definition
    A Azizi, HM Rafidah
    International Medical Journal Malaysia, 2017;16(1):3-9.
    MyJurnal
    Individuals with metabolic syndrome are at increased risk for developing cardiovascular disease and diabetes mellitus. This study was carried out to determine the prevalence of metabolic syndrome and clinical characteristics in hypertensive patients according to the criteria of the new International Diabetes Federation (IDF) definition. Hypertensive patients were recruited from the Medical Out-Patient Department, Kuantan Hospital. The five components of metabolic syndrome were examined which included blood pressure (≥130/85 mmHg), fasting glucose (≥5.6mmol/L), fasting triglycerides (≥1.7 mmol/L), high-density lipoprotein (HDL) cholesterol level (80cm). Out of 139 hypertensive patients, there were 113 met all the selection criteria consisted of 61 male and 52 female subjects. The participants’ age ranged from 21 to 91 years (51.9±16.8 years; mean±SD), and body mass index 13.5-42.3 kg/m2 (27.5±4.9 kg/m2). According to the IDF criteria, the prevalence of central obesity was 67.2% in men and 84.6% in women. Among the 113 hypertensive subjects over 21 years of age, 51 subjects or 45.1% had metabolic syndrome. The present data revealed that there was high prevalence of metabolic syndrome in Malaysian hypertensive subjects. This finding was supported by the fact of high prevalence of central obesity among the study subjects.
    Study site: Medical clinic, Hospital Kuantan, Pahang, Malaysia
    Matched MeSH terms: Hospitals, General
  2. Fulltext Accidental poisoning in children below 12 years admitted in Seremban Hospital 1994-1995
    Ab Ghani N
    Malaysian Journal of Public Health Medicine, 2003;3(1):62-67.
    MyJurnal
    Accidental poisoning in children is a preventable condition. It is a problem mainly in children aged 1 to 4 years. This is a descriptive study of accidental poisoning in children below 12 years old admitted to Hospital Seremban from October 15, 1994 to October 14, 1995. A major cause of household accidental poisoning was kerosene ingestion (25%) followed by ingestion of medications (22%), liniment methyl salicylate (12 %), mothballs (12%) and hypochlorinate solution (9%). There was a higher incidence of poisoning in males (50.8%), among Indians (41.2%) and in children from lower social classes (67%). A greater proportion of the accident occurred when the child was taken care by the parents (53 %) and in the house (80%). Most of the poison was ingested from its original package (81%). The immediate action taken was sending the child to the hospital (75%) without carrying out other actions such as washing the child’s mouth. The delay of sending the child to hospital was due to husband not at home (57%). Most of the cases (72.1 %) were discharged well within 1-2 days following admission.
    Matched MeSH terms: Hospitals, General
  3. The use of lamotrigine and other antiepileptic drugs in paediatric patients at a Malaysian hospital
    Ab Rahman AF, Ibrahim MI, Ismail HI, Seng TB
    Pharm World Sci, 2005 Oct;27(5):403-6.
    PMID: 16341748
    OBJECTIVE: (1) To determine the effect of lamotrigine add-on therapy on the seizure frequency and cost in paediatric patients. (2) To determine the prescribing pattern of other antiepileptic drugs (AEDs).

    METHOD: A retrospective study of medical records was carried out from October 2000 to June 2001 at the paediatric clinic, Hospital Pulau Pinang.

    MAIN OUTCOME MEASURE: Seizure frequency, cost of drug and types of AED prescribed.

    RESULTS: A total of 209 medical records were retrieved during the study period. Lamotrigine (LTG) was prescribed in 29 patients as add-on therapy. In 18 patients, there was a significant reduction in seizure frequency after the addition of LTG. Approximately 70% experienced a reduction in seizure frequency of more than 50%. Side effects of LTG were considered mild and manageable. However, drug cost after the addition of LTG increased by 103%. In the remaining 180 patients, the most common AED prescribed was sodium valproate (VPA). Only 15% of the patients received combination therapy. Mean monthly cost of monotherapy was found to be RM 24.4 while monthly cost of combination therapy was RM 45.4 (1 Euro-RM 5.00).

    CONCLUSION: The majority of paediatric patients in the study are on AED monotherapy and only a small percentage was prescribed lamotrigine. The use of lamotrigine is associated with better seizure control but with an increase in drug cost.

    Study site: paediatric clinic, Hospital Pulau Pinang.
    Matched MeSH terms: Hospitals, General
  4. Fulltext Psychosis in Parkinson's disease patients
    Abdul Hamid Abdul Rahman, Suriati Mohamed Saini, Ibrahim Abu Samah
    ASEAN Journal of Psychiatry, 2013;14(2):96-102.
    MyJurnal
    The objective of this study is to determine the prevalence and factors associated with psychosis in Parkinson’s disease (PD) patients.
    Method: This is a cross-sectional study of 108 PD patients from neurological clinic UKM Medical Centre and Kuala Lumpur Hospital. The patients were recruited from August to December 2004. Psychosis was determined using SCID, the severity of psychosis was rated using BPRS. The cognitive functions were evaluated with MMSE and the severity of depression was assessed with HAM-D.
    Results: The result shows that the prevalence of psychosis in Parkinson's disease patients in this sample was 13%. The psychosis was found to be significantly associated with advancing age, duration of illness, severity of depression and cognitive impairment. Multivariate analysis demonstrates that severity of depression (OR = 1.08, 95% C.I. = 1.01 - 1.16) and advancing age (OR = 4.72, 95% C.I. = 1.37 - 16.29) increased risk of psychosis in PD patients.
    Conclusion: We found that advancing age and severity of depression increase risk to develop psychosis in patients with PD.

    Study site: neurological clinic UKM Medical Centre and Kuala Lumpur Hospita
    Matched MeSH terms: Hospitals, General
  5. Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre
    Abdul Kader MAS
    Med J Malaysia, 2019 08;74(4):355-358.
    PMID: 31424052
    The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.
    Matched MeSH terms: Hospitals, General/organization & administration*
  6. Fulltext Physician adherence to hypertension treatment guidelines and drug acquisition costs of antihypertensive drugs at the cardiac clinic: a pilot study
    Abdulameer SA, Sahib MN, Aziz NA, Hassan Y, Alrazzaq HA, Ismail O
    Patient Prefer Adherence, 2012;6:101-8.
    PMID: 22346346 DOI: 10.2147/PPA.S27223
    Prescribing pattern surveys are one of the pharmacoepidemiological techniques that provide an unbiased picture of prescribing habits. Prescription surveys permit the identification of suboptimal prescribing patterns for further evaluation. The aims of this study were to determine the prescribing trend, adherence of the prescribers to the guideline, and the impact of drug expenditure on drug utilization at the cardiac clinic of Penang Hospital, Malaysia. This was a cross-sectional study. Demographic data of the patients, diagnoses and the drugs prescribed were recorded. The average drug acquisition costs (ADAC) were calculated for each antihypertensive drug class on a daily and annual basis. Adherence to the guideline was calculated as a percentage of the total number of patients. A total of 313 individuals fulfilled the inclusion criteria. The average age of the study population was 59.30 ± 10.35 years. The mean number of drugs per prescription in the study was 2.09 ± 0.78. There were no significant differences in the demographic data. Antihypertensive drugs were used in monotherapy and polytherapy in 20.8% and 79.2% of the patients, respectively. Adherence to the guideline regarding prescription occurred in 85.30% of the patients. The lowest priced drug class was diuretics and the highest was angiotensin-receptor blockers. In conclusion, the total adherence to the guideline was good; the adherence percentage only slightly decreased with a co-existing comorbidity (such as diabetes mellitus). The use of thiazide diuretics was encouraged because they are well tolerated and inexpensive, and perindopril was still prescribed for diabetic patients since it is relatively cheap (generic drug) and its daily dosage is beneficial.

    Study site: cardiac clinic of Penang Hospital, Malaysia
    Matched MeSH terms: Hospitals, General
  7. Fulltext The prevalence of osteopenia and osteoporosis among Malaysian type 2 diabetic patients using quantitative ultrasound densitometer
    Abdulameer SA, Sahib MN, Sulaiman SAS
    Open Rheumatol J, 2018;12:50-64.
    PMID: 29755605 DOI: 10.2174/1874312901812010050
    Background: Type 2 Diabetes Mellitus (T2DM) and osteoporosis are both chronic conditions and the relationship between them is complex.
    Objective: The aims of this study were to assess the prevalence of Low Bone Mineral density (LBMD, i.e., osteopenia and osteoporosis), as well as, the difference and associations between Quantitative Ultrasound Scan (QUS) parameters with socio-demographic data and clinical related data among T2DM in Penang, Malaysia.
    Method: An observational, cross-sectional study with a convenient sample of 450 T2DM patients were recruited from the outpatient diabetes clinic at Hospital Pulau Pinang (HPP) to measure Bone Mineral Density (BMD) at the heel bone using QUS. In addition, a self-reported structured questionnaire about the socio-demographic data and osteoporosis risk factors were collected. Moreover, the study included the retrospective collection of clinical data from patients' medical records.
    Results: The mean value of T-score for normal BMD, osteopenic and osteoporotic patients' were (-0.41±0.44), (-1.65±0.39) and (-2.76±0.27), respectively. According to QUS measurements, more than three quarters of T2DM patients (82%) were at high risk of abnormal BMD. The results showed that QUS scores were significantly associated with age, gender, menopausal duration, educational level and diabetic related data. Moreover, the QUS parameters and T-scores demonstrated significant negative correlation with age, menopausal duration, diabetic duration and glycaemic control, as well as, a positive correlation with body mass index and waist to hip ratio. The current study revealed that none of the cardiovascular disease risk factors appear to influence the prevalence of low BMD among T2DM Malaysian patients.
    Conclusion: The study findings revealed that the assessment of T2DM patients' bone health and related factor are essential and future educational programs are crucial to improve osteoporosis management.
    Study site: Diabetes clinic, Hospital Pulau Pinang
    Matched MeSH terms: Hospitals, General
  8. Fulltext The use of febuxostat for gout in Hospital Tengku Ampuan Afzan (HTAA) Kuantan. [Abstract]
    Abdullah H
    International Medical Journal Malaysia, 2017;16(11):50.
    MyJurnal
    Introduction: Febuxostat is a non-purine-selective oral xanthine oxidase inhibitor drug, and is an alternative to Allopurinol to lower serum uric acid in gout patients. It is probably more effective than Allopurinol, however, its use is limited because of its cost and availability. Allopurinol has been the mainstay treatment for gout for about 50 years. However, its use has been associated with allergic reactions especially in patients with renal impairment.The objective of this study was to describe HTAA Rheumatology Unit experiences with Febuxostat in the management of gout.
    Materials and method: Case records belonging to 6 patients who had been started on Febuxostat between January 2012 and January 2017 were analysed.
    Results: The majority of patients on Febuxostat were males (83.3%) as well as Malays (83.3%). About 66.7% of patients had already developed mild to moderate chronic kidney disease (GFR between 30-89 mL/min) due to multifactorial causes by the time they were started on Febuxostat. Also 33% of patients had mild liver impairment (ALT & AST < 1.5 ULN) due to fatty liver prior to Febuxostat. All patients had been started on Febuxostat due to allergic reactions to Allopurinol. All patients were on Febuxostat 40 mg once a day. Following Febuxostat, a significant decrease in the uric acid levels much closer to the target level i.e. less than 360 µmol/L were achieved in all patients. Only 1 patient (16.7%) developed a side effect i.e. ALT > 1.5 ULN while the rest tolerated the drug very well.
    Conclusion: Although the number of patients analysed was small, Febuxostat was shown to be very effective and safe for use in patients with gout even with concomitant mild to moderate renal impairment. Serum uric acid levels reduced significantly while on the lowest dose of 40 mg once a day.
    Matched MeSH terms: Hospitals, General
  9. Fulltext Risk factors for prolonged mechanical ventilation post cardiac surgery in Al Thawra Hospital, Sana'a, Yemen
    Abdulrahman Al Aizary, Faiz Daud
    Int J Public Health Res, 2016;6(1):700-706.
    MyJurnal
    Introduction Prolonged mechanical ventilation among cardiac surgery patient has been
    found to be correlated with negative clinical outcome and increased
    healthcare resources utilization. Prolonged mechanical ventilation (PMV)
    was defined as the accumulative duration of 24 hours or more of
    postoperative endotracheal intubation starting from transfer of the patient to
    cardiac ICU. This study is aimed to identify the risk factors preoperative,
    intra operative and postoperative for prolonged ventilation among cardiac
    patients in AL-Thawra Modern General Hospital (TMGH).

    Methods Observational study design was conducted during a two-month period (from
    1 August 2014 to 30 September 2014). It was among 70 patients who were
    admitted to cardiac surgery intensive care unit in Al-Thawra Modern General
    Hospital and selected by convenient sampling. The soci-demographic
    characteristic and clinical patient data were collected using short
    questionnaire developed by researcher. All patients had the same anesthetic
    and postoperative management. Statistical analysis was performed with SPSS
    version 20 and using bivariate analysis and multivariate logistic regression.
    The p-value of < 0.05 was found to be statistically significant.

    Results Incidence of prolonged mechanical ventilator post cardiac surgery was 37.1%
    (26/70) through bivariate analysis, multivariate logistic regression. Low
    Ejection fraction of Left Ventricle was inversely related to mechanical
    ventilation time (AOR= 0.872) with 95% confidence interval [0.790 - 0.963],
    hemodynamic instability were associated with prolonged mechanical
    ventilation time (AOR=16.35) with 95% confidence interval [2.558 -
    104.556].

    Conclusion Low ejection fraction of Left Ventricle and Hemodynamic Instability post
    operation were identified risk factors for prolonged mechanical ventilation
    post cardiac surgery.
    Matched MeSH terms: Hospitals, General
  10. Fulltext Does the duration of smoking cessation have an impact on hospital admission and health-related quality of life amongst COPD patients?
    Abu Hassan H, Abd Aziz N, Hassan Y, Hassan F
    Int J Chron Obstruct Pulmon Dis, 2014;9:493-8.
    PMID: 24868154 DOI: 10.2147/COPD.S56637
    BACKGROUND: Lack of awareness among ex-smokers on the benefits of sustaining smoking cessation may be the main cause of their smoking relapse. This study explored health-related quality of life (HRQoL) and hospital admission amongst chronic obstructive pulmonary disease (COPD) patients according to the duration of smoking cessation.
    MATERIALS AND METHODS: This study recruited COPD patients from a chest clinic who agreed to participate in a medication therapy-adherence program from January to June 2013. They were interviewed during their visits to obtain information regarding their smoking history and HRQoL. They were divided into three groups according to smoking status (sustained quitters, quit ≥5 years; quitters, quit <5 years; and smokers, smoking at least one cigarette/day). The effects of the duration of cessation on HRQoL and hospital admission were analyzed using a multinomial logistic model.
    RESULTS: A total of 117 participants with moderate COPD met the inclusion criteria, who were comprised of 41 sustained quitters, 40 quitters, and 36 smokers. Several features were similar across the groups. Most of them were married elderly men (aged >64 years) with low-to-middle level of education, who smoked more than 33 cigarettes per day and had high levels of adherence to the medication regimen. The results showed that sustained quitters were less likely to have respiratory symptoms (cough, phlegm and dyspnea) than smokers (odds ratio 0.02, confidence interval 0-0.12; P<0.001). The hospital admission rate per year was increased in quitters compared to smokers (odds ratio 4.5, confidence interval 1.91-10.59; P<0.005).
    CONCLUSION: A longer duration of quitting smoking will increase the benefits to COPD patients, even if they experience increased episodic respiratory symptoms in the early period of the cessation. Thus, the findings of this study show the benefits of early smoking cessation.
    KEYWORDS: HRQoL; chronic obstructive pulmonary disease (COPD); hospital admission and hospital stay
    Study site: Chest Clinic, Hospital Melaka, Malaysia
    Matched MeSH terms: Hospitals, General
  11. An assessment of adherence to asthma medication guidelines: findingsfrom a tertiary care center in the state of Penang, Malaysia
    Aftab RA, Khan AH, SYed Sulaiman SA, Ali I, Hassali A, Saleem F
    Turk J Med Sci, 2016 Nov 17;46(5):1300-1305.
    PMID: 27966326 DOI: 10.3906/sag-1405-45
    BACKGROUND/AIM: Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility.
    MATERIALS AND METHODS: A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated.
    RESULTS: One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit).
    CONCLUSION: Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.
    Study site: Respiratory clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia
    Matched MeSH terms: Hospitals, General
  12. Guidelines adherence and hypertension control at a tertiary hospital in Malaysia
    Ahmad N, Hassan Y, Tangiisuran B, Meng OL, Abd Aziz N, Ahmad FU, et al.
    J Eval Clin Pract, 2013 Oct;19(5):798-804.
    PMID: 22583820 DOI: 10.1111/j.1365-2753.2012.01852.x
    RATIONALE, AIMS AND OBJECTIVES: Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and factors associated with guideline adherence and hypertension control.
    METHODS: This was a cross-sectional study conducted at Hospital Pulau Pinang, Penang, Malaysia. Prescriptions written by 26 enrolled doctors to 650 established hypertensive outpatients (25 prescriptions per enrolled doctor) were noted on visit 1 along with patients' demographic and clinical data. The noted prescriptions were classified either as compliant or non-compliant to CPG (2008). Five hundred twenty (80%) of the enrolled patients (20 patients per enrolled doctor) were followed for one more visit. Blood pressure (BP) noted on visit 2 was related to the prescription written on visit 1. SPSS 16 (SPSS Inc., Chicago, IL, USA) was used for data analysis.
    RESULTS: Three hundred forty-nine (67.1%) patients received guidelines compliant pharmacotherapy. In multivariate analysis, hypertension clinic had significant negative association with guidelines adherence. Two hundred sixty-five patients (51%) were at goal BP on visit 2. In multivariate analysis, angiotensin-converting enzyme inhibitors and guidelines adherence had significant positive, while renal disease, diabetes mellitus and diabetic clinic had significant negative association with hypertension control.
    CONCLUSIONS: An overall fair level of adherence with guidelines and better control of hypertension was observed. Guidelines compliant practices resulted in better control of hypertension. The gaps between what guidelines recommend and clinical practice were especially seen in the pharmacotherapy of uncomplicated hypertension and hypertension with diabetes mellitus and renal disease.
    KEYWORDS: Malaysia; adherence; guidelines; hypertension
    Study site: Cardiology, nephrology, diabetic and hypertension clinics, Hospital Pulau Pinang, Malaysia
    Matched MeSH terms: Hospitals, General
  13. Fulltext Fentanyl pre-treatment alleviates pain during injection of propofol-lipuro premixed with lignocaine
    Ahmad N, Zanariah Y, Balan S
    Med J Malaysia, 2008 Dec;63(5):431-3.
    PMID: 19803312
    We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.
    Matched MeSH terms: Hospitals, General
  14. Fulltext Doctors' knowledge of hypertension guidelines recommendations reflected in their practice
    Ahmad N, Khan AH, Khan I, Khan A, Atif M
    Int J Hypertens, 2018;2018:8524063.
    PMID: 29721335 DOI: 10.1155/2018/8524063
    Aim: To evaluate doctors' knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008).
    Methods: Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors' knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis.
    Results: Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines' recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15 ± 1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5-20). Statistically significant correlation (rs = 0.635, P < 0.001) was observed between doctors' knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P = 0.008), left ventricular hypertrophy (OR = 0.091, P = 0.001) and heart failure (OR = 1.923, P = 0.039) were significantly associated with guidelines adherence.
    Conclusion: Doctors' knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.
    Study site: Cardiology, nephrology, diabetic, and hypertension clinics of Hospital Pulau Pinang, Malaysia
    Matched MeSH terms: Hospitals, General
  15. Fulltext Disease impact and patient insight--a study on a local population of asthmatics
    Ahmad NS, Chan MY, Hiew FL, Sharif SA, Vijayasingham P, Thayaparan T, et al.
    Med J Malaysia, 2003 Oct;58(4):526-32.
    PMID: 15190628
    The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.
    Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban; Klinik Kesihatan Ampangan, Malaysia
    Matched MeSH terms: Hospitals, General
  16. Fulltext Self-efficacy of foot care behaviour of elderly patients with diabetes
    Ahmad Sharoni SK, Mohd Razi MN, Abdul Rashid NF, Mahmood YE
    Malays Fam Physician, 2017;12(2):2-8.
    PMID: 29423123 MyJurnal
    Introduction: Elderly patients with diabetes are at a high risk of contracting diabetic foot problems. Self-efficacy is essential to help improve foot care behaviour.

    Aim: To identify levels of self-efficacy and foot care behaviour and their relationship with demographic characteristics in elderly patients with diabetes.

    Methods: A cross-sectional study was conducted in two general hospitals in Malaysia from May to June 2015. Diabetes patients aged 60 years with specific inclusion criteria were invited to participate in this study. The respondents were interviewed using a set of validated questionnaires. Data were analysed with descriptive and inferential statistics (multiple linear regression) using Statistical Package for the Social Sciences version 20.0.

    Results: Levels of foot self-efficacy (mean+31.39; standard deviation=7.76) and foot care behaviour (mean=25.37; SD=5.88) were high. There was a positive significant relationship between foot self-efficacy (β = 0.41, p < 0.001) and gender (β = 0.30, p < 0.001) with foot care behaviour.

    Conclusion: Self-efficacy can be incorporated in diabetes education to improve foot care behaviour. High-risk patients should be taught proper foot inspection and protection as well as the merits of skin care to prevent the occurrence of diabetic foot problems.

    Matched MeSH terms: Hospitals, General
  17. Fulltext Health beliefs predict self-care practices and glycaemic control in Malaysian patients with insulin-treated diabetes: a longitudinal study
    Aishairma Aris, Blake H, Adams G
    Malaysian Journal of Public Health Medicine, 2017;17(2):80-89.
    The practice of diabetes self-care plays an important role in achieving and maintaining good glycaemic control. However, not all patients with insulin-treated diabetes engage in their self-care activities. There is some evidence that self-care practices in patients with insulin-treated diabetes can be understood and predicted by their health beliefs, although studies are often hampered by methodological weaknesses, and the fact that less is known about adults with insulin-treated diabetes in Malaysia. This study was conducted to examine whether health beliefs (as specified in the Health Belief Model: HBM) can predict self-care practices and glycaemic control in patients with insulin-treated diabetes in Malaysia. Longitudinal design with self-reported questionnaire measures was administered at baseline (Time 1:T1) and six months later (Time 2: T2). Participants were recruited from three endocrinology clinics in Malaysia. The measures included self-care practices (diet, insulin intake, exercise and self-blood glucose monitoring: SMBG), health beliefs and diabetes knowledge. Participants’ glycaemic control was examined based on their glycated hemoglobin (HbA1c) results. Data analysis was performed at different points of the study times; T1, T1-T2 and T2. Diabetes knowledge and demographic data were controlled for in predictive statistical analyses. A total of 159 patients with insulin-treated diabetes (aged 18-40 years) completed the measures at T1. Of these, only 108 (67.9%) completed follow-up measures at T2. However, demographic characteristics were not significantly different between those who completed and dropped out of the study (p>0.05). The HBM was significantly predictive of diet self-care at T2, insulin intake practice at T1 and HbA1c at T1-T2 andT2. Of the HBM constructs, perceived benefits significantly predicted good dietary habits at T1 (OR 1.92) and T2 (OR .23) and adherence to insulin injection at T1 (OR 3.17) and T1-T2 (OR 2.68). With the exception of perceived severity, all other HBM constructs significantly predicted HbA1c [perceived susceptibility (β .169) at T1, perceived barriers (β -.206) and perceived benefits (β -.397) at T2 and cues to action (β -.233) at T1-T2]. Health beliefs predict self-care practices and glycaemic control in young to middle-aged adults with insulin-treated diabetes in Malaysia. Diabetes educators could use this knowledge in their efforts to improve diabetes self-care in this patient groupby modifying those beliefs through their diabetes education.
    Study site: Endocrinology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Hospital Putrajaya, and Hospital Melaka, Malaysia
    Matched MeSH terms: Hospitals, General
  18. Fulltext The expression of p53 in invasive ductal carcinoma of the breast: a study in the North-East States of Malaysia
    Al-Joudi FS, Iskandar ZA, Rusli J
    Med J Malaysia, 2008 Jun;63(2):96-9.
    PMID: 18942291
    The p53 gene is a tumour suppressor gene that encodes a 393-amino-acid nuclear DNA-binding phosphoprotein. The significance of p53 detection is that p53 mutation is linked with chemo-resistance and transformation to more aggressive disease in a large number of tumour types and it was confirmed that mutant p53 is involved in neoplastic transformations. In addition, the expression of p53 has been closely correlated with clinicopathological findings. Since breast cancer has been reported as one of the most frequent malignancies in women in Malaysia, the expression of p53 was studied in 382 cases of invasive ductal carcinoma of the breast, obtained from three major hospitals in the North-East States of Malaysia. The study utilized an enzyme immunohistochemistry assay for the detection of p53. It was found that p53 was expressed in 29.6% of all the study cases. Furthermore, its expression was significantly correlated with the age and the clinical grading of the disease. No significant statistical correlations were depicted with lymph node status, tumour size, side of tumour, and expression of estrogen and progesterone receptors. Nevertheless, knowledge of the p53 status may be valuable in making clinical decisions regarding diagnosis, prognosis and therapy.
    Matched MeSH terms: Hospitals, General
  19. Fulltext The 14-item Michigan Diabetes Knowledge Test: translation and validation study of the Malaysian version
    Al-Qazaz HK, Syed Sulaiman SA, Hassali MA, Shafie AA, Sundram S
    Practical Diabetes International, 2010;27(6):238-241a.
    DOI: 10.1002/pdi.1495
    The aims of this study were to translate the Michigan Diabetes Knowledge Test (MDKT) into the Malaysian language, and to examine the psychometric properties of the Malaysian version. A standard translation procedure was used to create the Malaysian version of the MDKT from the original English version. A convenience sample of 307 outpatients with type 2 diabetes was identified between May and October 2009. All data were collected from the Penang General Hospital, Penang, Malaysia. Instruments consisted of the Malaysian version of the MDKT and a socio-demographic questionnaire. Medical records were reviewed for haemoglobin A1c (HbA1c) levels and other clinical data. Reliability was tested for internal consistency using Cronbach’s alpha coefficient. Employing the recommended scoring method, the mean±SD of MDKT scores was 7.88±3.01. Good internal consistency was found (Cronbach’s alpha = 0.702); the test-retest reliability value was 0.894 (p<0.001). For known group validity, a significant relationship between MDKT categories and HbA1c categories (chi-square = 21.626; p≥0.001) was found. The findings of this validation study indicate that the Malaysian version of the MDKT is a reliable and valid measure of diabetes knowledge which can now be used in clinical and research practice.
    KEY WORDS: diabetes knowledge; validation; Michigan test; translation
    Study site: Diabetes Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia.
    Matched MeSH terms: Hospitals, General
  20. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes
    Al-Qazaz HKh, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al.
    Int J Clin Pharm, 2011 Dec;33(6):1028-35.
    PMID: 22083724 DOI: 10.1007/s11096-011-9582-2
    BACKGROUND: Most of interventions that have attempted to improve medication adherence in type 2 diabetes have been educational; on the assumption that knowledge regarding diabetes might affect patients' adherence to their treatment regimen.
    OBJECTIVES: The purpose of the study was to investigate any association of knowledge and medication adherence with glycemic control in patients with type 2 diabetes mellitus. Setting The study was conducted at the Diabetes Outpatients Clinic, Hospital Pulau Pinang.
    METHODS: A cross-sectional study was conducted with a convenience sample of 540 adult patients with type 2 diabetes attending the clinic. A questionnaire including previously validated Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used and the patients' medical records were reviewed for haemoglobin A1C (HbA1C) levels and other disease-related information. A total of 35 (6.48%) patients were excluded after data collection due to lack of HbA1C results.
    RESULTS: Five hundred and five patients were included in the final analysis, with a mean age of 58.15 years (SD = 9.16), 50.7% males and median HbA1C of 7.6 (IQR was 6.7-8.9). The median total knowledge score was 7.0 (IQR was 5.0-10.0) while the median adherence score was 6.5 (IQR was 4.75-7.75). Significant correlations were found between the three variables (HbA1C, knowledge and adherence). A significantly higher score for knowledge and adherence (P < 0.05) was found in those patients with lower HbA1C. Higher diabetes knowledge, higher medication adherence and using mono-therapy were significant predictors of good glycemic control in the multivariate analysis.
    CONCLUSION: Patients' knowledge about diabetes is associated with better medication adherence and better glycemic control. In addition to other factors affecting medication adherence and glycemic control, healthcare providers should pay attention to knowledge about diabetes that the patients carry towards medication adherence.

    Study site: Diabetes Outpatients Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia
    Matched MeSH terms: Hospitals, General
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