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Fulltext Challenges in managing HIV in people who use drugs

Kamarulzaman A, Altice FL

Curr. Opin. Infect. Dis., 2015 Feb;28(1):10-6.
PMID: 25490106 DOI: 10.1097/QCO.0000000000000125

HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities.

Matched MeSH terms: Continuity of Patient Care
Requirements for the development of a hand transplantation program

Gordon CR, Siemionow M

Ann Plast Surg, 2009 Sep;63(3):262-73.
PMID: 19692900 DOI: 10.1097/SAP.0b013e31818d45e9

Since 1998, 42 hand transplants in 30 patients have been performed in countries such as France, United States, China, Austria, Malaysia, Italy, Belgium, Poland, Spain, and Germany. Now, with recent improvements in immunosuppression, the clinical applicability may expand and the ethical obstacles may soon be overcome, allowing multiple US institutions to perform hand allotransplantation. The main purpose of this article is to facilitate access to pertinent details in regards to hand transplantation, such as donor/recipient selection criteria, immunosuppressive therapies, and associated complications. It is a comprehensive literature review compiled from published reports from multiple hand transplant programs throughout the world. Due to its inherent complexity, hand transplantation should only be attempted at institutions within the US capable of orchestrating a specialized multidisciplinary team, and each institution's protocol should be extremely detailed and individualized.

Matched MeSH terms: Patient Care Team
Pharmacotherapeutic considerations for the management of diabetes mellitus among hospitalized COVID-19 patients

Hasan SS, Kow CS, Bain A, Kavanagh S, Merchant HA, Hadi MA

Expert Opin Pharmacother, 2021 Feb;22(2):229-240.
PMID: 33054481 DOI: 10.1080/14656566.2020.1837114

INTRODUCTION: Diabetes mellitus is one of the most prevalent comorbidities identified in patients with coronavirus disease 2019 (COVID-19). This article aims to discuss the pharmacotherapeutic considerations for the management of diabetes in hospitalized patients with COVID-19.
AREAS COVERED: We discussed various aspects of pharmacotherapeutic management in hospitalized patients with COVID-19: (i) susceptibility and severity of COVID-19 among individuals with diabetes, (ii) glycemic goals for hospitalized patients with COVID-19 and concurrent diabetes, (iii) pharmacological treatment considerations for hospitalized patients with COVID-19 and concurrent diabetes.
EXPERT OPINION: The glycemic goals in patients with COVID-19 and concurrent type 1 (T1DM) or type 2 diabetes (T2DM) are to avoid disruption of stable metabolic state, maintain optimal glycemic control, and prevent adverse glycemic events. Patients with T1DM require insulin therapy at all times to prevent ketosis. The management strategies for patients with T2DM include temporary discontinuation of certain oral antidiabetic agents and consideration for insulin therapy. Patients with T2DM who are relatively stable and able to eat regularly may continue with oral antidiabetic agents if glycemic control is satisfactory. Hyperglycemia may develop in patients with systemic corticosteroid treatment and should be managed upon accordingly.

Matched MeSH terms: Patient Care Planning
Fulltext Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial

Ting CY, Ahmad Zaidi Adruce S, Hassali MA, Ting H, Lim CJ, Ting RS, et al.

Trials, 2018 Jun 05;19(1):310.
PMID: 29871651 DOI: 10.1186/s13063-018-2649-9

BACKGROUND: Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program.
METHODS/DESIGN: This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score <6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8.
DISCUSSION: This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program.
TRIAL REGISTRATION: National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.

Matched MeSH terms: Patient Care Team
Fulltext Dental consultation in patients planned for/undergoing/post radiation therapy for head and neck cancers: a questionnaire-based survey

Mainali A, Sumanth KN, Ongole R, Denny C

Indian J Dent Res, 2011 Sep-Oct;22(5):669-72.
PMID: 22406711 DOI: 10.4103/0970-9290.93454

Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients.

Matched MeSH terms: Patient Care Planning
Zygomatic implant-retained fixed complete denture for an elderly patient

Baig MR, Rajan G, Yunus N

Gerodontology, 2012 Jun;29(2):e1140-5.
PMID: 21615782 DOI: 10.1111/j.1741-2358.2010.00433.x

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics.

Matched MeSH terms: Patient Care Planning
Mirtazapine for anorexia nervosa with depression

Jaafar NR, Daud TI, Rahman FN, Baharudin A

Aust N Z J Psychiatry, 2007 Sep;41(9):768-9.
PMID: 17687663

To report the use of Mirtazapine in the treatment of anorexia nervosa with depression primarily regarding its propensity for weight gain.

Matched MeSH terms: Patient Care Team
Social factors in relation to physical abuse in Kuala Lumpur, Malaysia

Kasim MS, Shafie HM, Cheah I

Child Abuse Negl, 1994 May;18(5):401-7.
PMID: 8032970

Available evidence has shown that the type of abuse perpetrated on children depends considerably on the social and other factors inherently faced by these children. A total of 119 cases of physical abuse was detected by the Suspected Child Abuse and Neglect (SCAN) Team of General Hospital, Kuala Lumpur in 1991. Eighty-two cases were categorized as mild and 37 as severe. The average age of those mildly abused was 7.9 years, for those severely abused the average age was 4.2 years. The perpetrators of those mildly abused were often their own parents. However, among those severely abused, the child-minder was the most frequent abuser. Ninety-two of all cases were in families of social classes IV and V. In 47 cases, there was definite evidence of family disharmony or disruption. Among the 37 severely abused, the parents were either divorced or separated in 14 cases. There was a personality disorder in seven of the cases. Six of the abusers were also using drugs and nine were alcoholics. This paper shows that, even in a developing country, the social milieu is important in the type of abuse inflicted.

Matched MeSH terms: Patient Care Team
Multidisciplinary education approach to optimize phosphate control among hemodialysis patients

Chan MW, Cheah HM, Mohd Padzil MB

Int J Clin Pharm, 2019 Oct;41(5):1282-1289.
PMID: 31302884 DOI: 10.1007/s11096-019-00878-4

Background Hyperphosphatemia is a common consequence in end stage renal disease. It is associated with increased cardiovascular risk and mortality, also development of hyperparathyroidism and mineral bone disease. A patient educational program involving physician, pharmacist and dietician was developed to manage hyperphosphatemia among hemodialysis patients. Objective To investigate the efficacy of the program in optimal phosphate control among hemodialysis patients. Setting Kuala Lipis Hospital, Malaysia. Method This was a non-randomized, single-arm community trial running for a period of 6 months. The program consisted of a small group seminar and individual counseling sessions. Two individual counseling sessions were conducted for each patient, focusing on diet and medication adherence, by an accredited dietician and pharmacist respectively. The group seminar was delivered by a multidisciplinary team involving a physician, pharmacist and dietician. Topics included basic knowledge of hyperphosphatemia, phosphate binder and dietary phosphate control. Eligible and consented patients had knowledge and medication adherence assessment, measurement of pre-dialysis serum calcium, albumin, phosphate, haemoglobin and alkaline phosphatase before and after the educational program. Main outcome measure Phosphate level, knowledge and medication adherence assessment. Results Fifty-seven patients completed the program and were included into final data analysis. The median (IQR) phosphate level (mmol/L) was 1.86 (1.45-2.24) before and decreased to 1.47 (1.21-1.91) and 1.49 (1.28-1.81) 3 months and 6 months after PEP (p patients with uncontrolled phosphate level was reduced from 59.3 to 35.6% and 42.1% after the PEP (p = 0.003). The mean knowledge score almost doubled after the intervention, with a mean pre-score of 8.61 (95% CI 7.85-9.37) to mean post-score of 15.31 (95% CI 14.85-15.76). The adherence to phosphate binder also improved from 17.2 to 41.4% after PEP (p = 0.007). Conclusion A multidisciplinary patient education program is an effective approach to manage hyperphosphatemia among hemodialysis patients in Malaysia.

Matched MeSH terms: Patient Care Team
Diagnostic ability of computed tomography using DentaScan software in endodontics: case reports

Siotia J, Gupta SK, Acharya SR, Saraswathi V

Int J Comput Dent, 2011;14(4):321-34.
PMID: 22324223

Radiographic examination is essential in diagnosis and treatment planning in endodontics. Conventional radiographs depict structures in two dimensions only. The ability to assess the area of interest in three dimensions is advantageous. Computed tomography is an imaging technique which produces three-dimensional images of an object by taking a series of two-dimensional sectional X-ray images. DentaScan is a computed tomography software program that allows the mandible and maxilla to be imaged in three planes: axial, panoramic, and cross-sectional. As computed tomography is used in endodontics, DentaScan can play a wider role in endodontic diagnosis. It provides valuable information in the assessment of the morphology of the root canal, diagnosis of root fractures, internal and external resorptions, pre-operative assessment of anatomic structures etc. The aim of this article is to explore the clinical usefulness of computed tomography and DentaScan in endodontic diagnosis, through a series of four cases of different endodontic problems.

Matched MeSH terms: Patient Care Planning
Fulltext Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions

Mohd Nordin NA, Aziz NA, Abdul Aziz AF, Ajit Singh DK, Omar Othman NA, Sulong S, et al.

BMC Health Serv Res, 2014;14:118.
PMID: 24606911 DOI: 10.1186/1472-6963-14-118

The importance of long term rehabilitation for people with stroke is increasingly evident, yet it is not known whether such services can be materialised in countries with limited community resources. In this study, we explored the perception of rehabilitation professionals and people with stroke towards long term stroke rehabilitation services and potential approaches to enable provision of these services. Views from providers and users are important in ensuring whatever strategies developed for long term stroke rehabilitations are feasible and acceptable.

Matched MeSH terms: Continuity of Patient Care
Clinical audit teaching in record-keeping for dental undergraduates at International Medical University, Kuala Lumpur, Malaysia

Chong JA, Chew JK, Ravindranath S, Pau A

J Dent Educ, 2014 Feb;78(2):206-12.
PMID: 24489028

This study investigated the impact of clinical audit training on record-keeping behavior of dental students and students' perceptions of the clinical audit training. The training was delivered to Year 4 and Year 5 undergraduates at the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia. It included a practical audit exercise on patient records. The results were presented by the undergraduates, and guidelines were framed from the recommendations proposed. Following this, an audit of Year 4 and Year 5 students' patient records before and after the audit training was carried out. A total of 100 records were audited against a predetermined set of criteria by two examiners. An email survey of the students was also conducted to explore their views of the audit training. Results showed statistically significant improvements in record-keeping following audit training. Responses to the email survey were analyzed qualitatively. Respondents reported that the audit training helped them to identify deficiencies in their record-keeping practice, increased their knowledge in record-keeping, and improved their record-keeping skills. Improvements in clinical audit teaching were also proposed.

Matched MeSH terms: Patient Care Planning
Structured student-generated videos for first-year students at a dental school in Malaysia

Omar H, Khan SA, Toh CG

J Dent Educ, 2013 May;77(5):640-7.
PMID: 23658411

Student-generated videos provide an authentic learning experience for students, enhance motivation and engagement, improve communication skills, and improve collaborative learning skills. This article describes the development and implementation of a student-generated video activity as part of a knowledge, observation, simulation, and experience (KOSE) program at the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia. It also reports the students' perceptions of an activity that introduced first-year dental students (n=44) to clinical scenarios involving patients and dental team aiming to improve professional behavior and communication skills. The learning activity was divided into three phases: preparatory phase, video production phase, and video-watching. Students were organized into five groups and were instructed to generate videos addressing given clinical scenarios. Following the activity, students' perceptions were assessed with a questionnaire. The results showed that 86 percent and 88 percent, respectively, of the students agreed that preparation of the activity enhanced their understanding of the role of dentists in provision of health care and the role of enhanced teamwork. In addition, 86 percent and 75 percent, respectively, agreed that the activity improved their communication and project management skills. Overall, the dental students perceived that the student-generated video activity was a positive experience and enabled them to play the major role in driving their learning process.

Matched MeSH terms: Patient Care Team
Fulltext Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

Chua SS, Kok LC, Yusof FA, Tang GH, Lee SW, Efendie B, et al.

BMC Health Serv Res, 2012;12:388.
PMID: 23145922 DOI: 10.1186/1472-6963-12-388

BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia.
METHODS: This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months.
RESULTS: Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended.
CONCLUSIONS: This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00490672.
Study name: Cardiovascular Risk Factors Intervention Strategies (CORFIS) trial

Matched MeSH terms: Patient Care Team
Telehealth: the backbone of healthcare financing

Suleiman AB

Stud Health Technol Inform, 2004;104:182-90.
PMID: 15747978 DOI: 10.3233/978-1-60750-947-9-182

Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.

Matched MeSH terms: Continuity of Patient Care
A pilot project on hospital-based universal newborn hearing screening: lessons learned

Mukari SZ, Tan KY, Abdullah A

Int J Pediatr Otorhinolaryngol, 2006 May;70(5):843-51.
PMID: 16246430

This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation.

Matched MeSH terms: Continuity of Patient Care
Fulltext Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study

Sellappans R, Lai PS, Ng CJ

BMJ Open, 2015 Aug 27;5(8):e007817.
PMID: 26316648 DOI: 10.1136/bmjopen-2015-007817

OBJECTIVE: The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia.
DESIGN/SETTING: 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach.
PARTICIPANTS: PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data.
RESULTS: 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen.
CONCLUSIONS: PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Continuity of Patient Care
Dentist-Urologist Interplay in the Dental Management of Penile Prosthesis Patient

Ramasamy C

J Coll Physicians Surg Pak, 2015 Aug;25(8):628.
PMID: 26305318 DOI: 08.2015/JCPSP.628628
Matched MeSH terms: Patient Care Team
A new concept in denture design for patients with few remaining teeth: case reports

Ling BC

Quintessence Int, 1995 Dec;26(12):871-7.
PMID: 8596818

This article presents an alternative to the conventional swing-lock de sign of removable partial denture construction. It incorporates the principles of sectional dentures as well as the swing-lock concept and overcomes some of the limitations of conventional swing-lock dentures. I-bar struts and stainless steel keepers form part of the first section of the denture. The second part of the denture consists of the denture base with the artificial teeth and magnetic retention units. This system has been used successfully in a number of patients whose situations were suitable for the conventional swing-lock design.

Matched MeSH terms: Patient Care Planning
Combined team management of diabetes mellitus in pregnancy

Ng CS, Lim LS, Chng KP, Lim P, Cheah JS, Yeo PP, et al.

Ann Acad Med Singap, 1985 Apr;14(2):297-302.
PMID: 4037689

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Matched MeSH terms: Patient Care Team

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