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  1. van der Werf ET, Redmond NM, Turnbull S, Thornton H, Thompson M, Little P, et al.
    Br J Gen Pract, 2019 Apr;69(681):e236-e245.
    PMID: 30858333 DOI: 10.3399/bjgp19X701837
    BACKGROUND: Severity assessments of respiratory tract infection (RTI) in children are known to differ between parents and clinicians, but determinants of perceived severity are unknown.

    AIM: To investigate the (dis)agreement between, and compare the determinants of, parent and clinician severity scores.

    DESIGN AND SETTING: Secondary analysis of data from a prospective cohort study of 8394 children presenting to primary care with acute (≤28 days) cough and RTI.

    METHOD: Data on sociodemographic factors, parent-reported symptoms, clinician-reported findings, and severity assessments were used. Kappa (κ)-statistics were used to investigate (dis) agreement, whereas multivariable logistic regression was used to identify the factors associated with illness severity.

    RESULTS: Parents reported higher illness severity (mean 5.2 [standard deviation (SD) 1.8], median 5 [interquartile range (IQR) 4-7]), than clinicians (mean 3.1 [SD 1.7], median 3 [IQR 2-4], P<0.0001). There was low positive correlation between these scores (+0.43) and poor inter-rater agreement between parents and clinicians (κ 0.049). The number of clinical signs was highly correlated with clinician scores (+0.71). Parent-reported symptoms (in the previous 24 hours) that were independently associated with higher illness severity scores, in order of importance, were: severe fever, severe cough, rapid breathing, severe reduced eating, moderate-to-severe reduced fluid intake, severe disturbed sleep, and change in cry. Three of these symptoms (severe fever, rapid breathing, and change in cry) along with inter/subcostal recession, crackles/crepitations, nasal flaring, wheeze, and drowsiness/irritability were associated with higher clinician scores.

    CONCLUSION: Clinicians and parents use different factors and make different judgements about the severity of children's RTI. Improved understanding of the factors that concern parents could improve parent-clinician communication and consultation outcomes.

    Matched MeSH terms: Physicians, Primary Care*
  2. Zulkifli A, Rogayah J
    Med J Malaysia, 1998 Dec;53(4):327-33.
    PMID: 10971974
    A survey of specialisation choices was conducted for two batches of medical officers applying to the local medical schools for specialisation in Malaysia. A total of 359 doctors responded, giving a response rate of 71%, with 169 male (44.4%) and 187 female (55.6%) respondents. Surgery ranked highest among the male doctors followed by orthopaedic surgery and internal medicine. Family medicine ranked highest among female doctors followed by public health and anaesthesiology. Among the other specialties, the male doctors preferred otorhinolaryngology while female doctors preferred Pathology. Both male and female doctors chose to be a clinical consultant in a general hospital as the first choice. They prefer to work in or near their hometowns.
    Matched MeSH terms: Physicians*
  3. Zin CS, Chen LC, Knaggs RD
    Eur J Pain, 2014 Oct;18(9):1343-51.
    PMID: 24756859 DOI: 10.1002/j.1532-2149.2014.496.x
    BACKGROUND: This study evaluated the prescribing trends of four commonly prescribed strong opioids in primary care and explored utilization in non-cancer and cancer users.
    METHODS: This cross-sectional study was conducted from 2000 to 2010 using the UK Clinical Practice Research Datalink. Prescriptions of buprenorphine, fentanyl, morphine and oxycodone issued to adult patients were included in this study. Opioid prescriptions issued after patients had cancer medical codes were defined as cancer-related use; otherwise, they were considered non-cancer use. Annual number of prescriptions and patients, defined daily dose (DDD/1000 inhabitants/day) and oral morphine equivalent (OMEQ) dose were measured in repeat cross-sectional estimates.
    RESULTS: In total, there were 2,672,022 prescriptions (87.8% for non-cancer) of strong opioids for 178,692 users (59.9% female, 83.9% non-cancer, mean age 67.1 ± 17.0 years) during the study period. The mean annual (DDD/1000 inhabitants/day) was higher in the non-cancer group than in the cancer group for all four opioids; morphine (0.73 ± 0.28 vs. 0.12 ± 0.04), fentanyl (0.46 ± 0.29 vs. 0.06 ± 0.24), oxycodone (0.24 ± 0.19 vs. 0.038 ± 0.028) and buprenorphine (0.23 ± 0.15 vs. 0.008 ± 0.006). The highest proportion of patients were prescribed low opioid doses (OMEQ ≤ 50 mg/day) in both non-cancer (50.3%) and cancer (39.9%) groups, followed by the dose ranks of 51-100 mg/day (26.2% vs. 28.7%), 101-200 mg/day (15.1% vs. 19.2%) and >200 mg/day (8.25% vs. 12.1%).
    CONCLUSIONS: There has been a huge increase in strong opioid prescribing in the United Kingdom, with the majority of prescriptions for non-cancer pain. Morphine was the most frequently prescribed, but the utilization of oxycodone, buprenorphine and fentanyl increased markedly over time.
    Matched MeSH terms: Practice Patterns, Physicians'/trends; Practice Patterns, Physicians'/statistics & numerical data*
  4. Zin CS, Nazar NI, Rahman NSA, Ahmad WR, Rani NS, Ng KS
    BMJ Open, 2019 07 02;9(7):e027203.
    PMID: 31270113 DOI: 10.1136/bmjopen-2018-027203
    OBJECTIVE: This study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients.

    DESIGN: This study was designed as a retrospective cohort study.

    SETTING AND PARTICIPANTS: In this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.

    MAIN OUTCOME MEASURES: The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.

    RESULTS: There were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.

    CONCLUSIONS: The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.

    Matched MeSH terms: Practice Patterns, Physicians'*
  5. Zheng B, Huo Y, Lee SW, Sawhney JPS, Kim HS, Krittayaphong R, et al.
    Clin Cardiol, 2020 Sep;43(9):999-1008.
    PMID: 32618009 DOI: 10.1002/clc.23400
    BACKGROUND: Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real-world AMPs up to 2 years post discharge for ACS.

    HYPOTHESIS: There is wide variability in AMP use for ACS management in Asia.

    METHODS: EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months.

    RESULTS: Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow-up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non-randomized study.

    CONCLUSIONS: Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.

    Matched MeSH terms: Practice Patterns, Physicians'/trends*
  6. Zandi G, Shahzad I, Farrukh M, Kot S
    PMID: 33138254 DOI: 10.3390/ijerph17217961
    Measurement of job stress and employees' commitment are few of the admired topics in the corporate world amongst business writers. With a principal aim to trial the blow of exposure to COVID-19 patients on doctors' job stress and commitment, in Pakistan; data have been collected through 7-10 min telephonic interview from voluntary participants and a sample of 129 responses were analyzed by Structure Equation Modeling-Partial Least Square (SEM-PLS) path modeling through Smart PLS 3.2. The results of the study indicated; direct positive & significant impact of Extent of Exposure on Job Stress while direct negative, significant association with Commitment. Job Stress also observed having direct negative impact on commitment. The Extent of Exposure-Job Stress relationship was also found stronger among group of doctors having Low level of Perceived Organizational Support and weaker among group of doctors having High level of Perceive Organizational support. Perceived Organizational Support showed a moderating effect on the Extent of Exposure-Job Stress relationship; while, Social Support showed no moderation. Researchers are required to investigate more and management of the medical services providers (both hospitals and government) needs to focus on doctors' perception about Organizational Support, as doctors show no concern about the support from society as long as their well-being is cared for by respective hospitals. This study is an effort to stimulate more empirical evidence towards the treating and handling of COVID-19 patients and the psychological well-being of doctors.
    Matched MeSH terms: Physicians/psychology*
  7. Zanaridah MN, Norhayati MN, Rosnani Z
    BMJ Open, 2021 Jun 01;11(6):e044372.
    PMID: 34078635 DOI: 10.1136/bmjopen-2020-044372
    OBJECTIVES: To determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.

    SETTING: This cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.

    PARTICIPANTS: The study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.

    RESULTS: A total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.

    CONCLUSIONS: Although many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

    Matched MeSH terms: Physicians, Primary Care
  8. Zakiah MJ, Nidzwani M, Hanizah N, Affirul CA
    Clin Ter, 2016;167(1):e1-5.
    PMID: 26980635 DOI: 10.7417/T.2016.1911
    The training of emergency medical officers has always been informal. Only recently, the presence of emergency physician may have a positive influence in their training and development. This study aims to determine the effect of Emergency Physician (EP) presence on the training exposure and confidence level of medical officers in their practice.
    Matched MeSH terms: Physicians
  9. Zaini S, Manivanna Bharathy HA, Sulaiman AH, Singh Gill J, Ong Hui K, Zaman Huri H, et al.
    PMID: 29970848 DOI: 10.3390/ijerph15071402
    Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

    Study site: University Malaya Medical Centre (UMMC)
    Matched MeSH terms: Physicians/psychology*
  10. Zahrina AZ, Haymond P, Rosanna P, Ho R, Rajini AR, Low BT, et al.
    Malays Fam Physician, 2018;13(3):3-11.
    PMID: 30800227
    INTRODUCTION: With increasing evidence of disease transmission through doctors' white coats, many countries have discouraged doctors from wearing their white coats during consultations. However, there have been limited studies about patients' preferences concerning doctors' attire in Malaysia. This study, therefore, aimed to investigate patients' perceptions of doctors' attire before and after the disclosure of information about the infection risk associated with white coats.
    METHOD: This cross-sectional study was conducted from 1st June 2015 to 31st July 2015 at three different primary care settings (government, private, and university primary care clinics) using a self-administered questionnaire. A 1:5 systematic random sampling method was employed to select the participants. The respondents were shown photographs of male and female doctors in four different types of attire and asked to rate their level of confidence and trust in and ease with doctors in each type of attire. Subsequently, the respondents were informed of the risk of white coat-carried infections, and their responses were reevaluated. Data analysis was completed using SPSS Version 24.0. Associations of categorical data were assessed using the Chi-Square test, while the overall change in perceptions after the disclosure of additional information was examined using the McNemar test. Results with p-values < 0.05 were considered statistically significant.
    RESULTS: A total of 299 respondents completed the questionnaire. Most of the respondents had more confidence and trust in the male (62.5%) and female (59.2%) doctors wearing white coats. A high proportion of the respondents from the government clinic (70.5%) felt more confidence in male doctors dressed in white coats (p-value = 0.018). In terms of ethnicity, male doctors in white coats were highly favored by Malays (61.0%), followed by the Chinese (41.2%) and Indians (38%) (p = 0.005). A similar preference was observed for the female doctors, whereby the highest number of Malays (60.3%), followed by the Chinese (41.2%) and Indians (40.0%) (p = 0.006), had a preference for female doctors wearing white coats. Only 21.9% of the initial 71.9% of patients who preferred white coats maintained their preference (p < 0.001) after learning of the risk of microbial contamination associated with white coats.
    CONCLUSION: Most patients preferred that primary care doctors wear white coats. Nevertheless, that perception changed after they were informed about the infection risk associated with white coats.
    Matched MeSH terms: Physicians, Primary Care
  11. Zaherah Mohamed Shah F, Suraiya HS, Poi PJ, Tan KS, Lai PS, Ramakrishnan K, et al.
    J Nutr Health Aging, 2012 Aug;16(8):701-6.
    PMID: 23076512 DOI: 10.1007/s12603-012-0027-y
    BACKGROUND: Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients.

    METHODOLOGY: A prospective comparison of subjective global assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding.

    RESULTS: 140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG.

    CONCLUSION: Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients.

    Matched MeSH terms: Practice Patterns, Physicians'
  12. Zabidi-Hussin ZA
    Med J Malaysia, 2007 Oct;62(4):275-7.
    PMID: 18551927 MyJurnal
    Matched MeSH terms: Practice Patterns, Physicians'/economics; Practice Patterns, Physicians'/statistics & numerical data*
  13. Z I I, C J N, P Y L, N H
    PLoS One, 2020;15(12):e0242690.
    PMID: 33270663 DOI: 10.1371/journal.pone.0242690
    INTRODUCTION: Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women's pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women's pregnancy planning.

    METHODS: This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.

    RESULTS: From the 33 interviews that were analysed, four important factors influencing participants' decisions regarding pregnancy planning were identified. Participants' perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious 'up to God' beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.

    CONCLUSIONS: This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.

    Matched MeSH terms: Physicians
  14. Yousuf, R.M., Mohammed Fauzi, A.R.
    MyJurnal
    Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.
    Matched MeSH terms: Physicians
  15. Yousuf RM, Fauzi AR, How SH, Rasool AG, Rehana K
    Singapore Med J, 2007 Jun;48(6):559-65.
    PMID: 17538757
    Informed consent is now accepted as the cornerstone of medical practice, with reasonable patient standards typically considered to be appropriate in the developed countries; however it is still challenged in many developing countries. The objective of this descriptive study was to evaluate the perceptions and practices among attending medical professionals in matters relating to informed consent in selected hospitals.
    Matched MeSH terms: Physicians
  16. Yong Rafidah AR
    Family Physician, 2003;12:1-1.
    Matched MeSH terms: Physicians, Family
  17. Yeoh PH
    Med J Malaysia, 1988 Sep;43(3):195-9.
    PMID: 3241576
    Matched MeSH terms: Physicians/supply & distribution*
  18. Yeap SS, Goh EM, Gun SC
    Int J Rheum Dis, 2009 Dec;12(4):329-35.
    PMID: 20374371 DOI: 10.1111/j.1756-185X.2009.01431.x
    AIM: The aim of this study was to ascertain the management of gout by doctors in Malaysia.
    METHODS: A cross-sectional questionnaire survey was carried out among doctors attending rheumatology post-graduate courses, where gout was not a lecture topic.
    RESULTS: A total of 128 questionnaires were analyzed, of which the majority (67: 52.3%) were general practitioners. In the treatment of acute gout, 68.0% use non-selective non-steroidal anti-inflammatory drugs (NSAIDs), 53.9% use selective COX-2 inhibitors (coxibs), 66.4% use colchicine and 10.2% use allopurinol (ALLO). In the treatment of chronic gout, 36.7% use NSAIDs, 44.5% use coxibs, 19.5% use colchicine and 93% use ALLO. In both acute and chronic gout, corticosteroids (CS) are not used by over 90% of respondents. Fifty percent would stop ALLO during an acute attack. 95.3% do not start ALLO during an acute attack; 87.5% would start ALLO after the attack, with a median of 14 days afterwards. Once ALLO was started, 54.7% would continue indefinitely. Regarding target urate levels while on treatment, 10.9% would be satisfied with a high normal range, 21.9% middle of the range, 18.0% low normal range and 45.3% anywhere within the normal range. Fifteen percent would treat asymptomatic hyperuricemia.
    CONCLUSIONS: In Malaysia, anti-inflammatory agents are most commonly used for the treatment of acute and chronic gout, with corticosteroid usage at a low level. However, there are areas of concern regarding the diagnosis of gout and the usage of ALLO which are not consistent with current guidelines
    Matched MeSH terms: Physicians
  19. Yau JW, Thor SM, Tsai D, Speare T, Rissel C
    Antimicrob Resist Infect Control, 2021 07 13;10(1):105.
    PMID: 34256853 DOI: 10.1186/s13756-021-00964-1
    BACKGROUND: Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies.

    METHODS: The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools.

    RESULTS: Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing.

    CONCLUSIONS: Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

    Matched MeSH terms: Physicians
  20. Yaroko A, Mohamad I, Hashim H
    Malays Fam Physician, 2014;9(1):30-2.
    PMID: 25606296 MyJurnal
    Rhinoliths result from neglected nasal foreign bodies that gradually increase in size. They are usually discovered incidentally during routine ENT examination or due to the associated symptoms such as nasal obstruction or persistent foul-smelling unilateral nasal discharge. A case of a 14-year-old girl was reported with a year history of the symptom. The foul-smelling nasal discharge noted by her mother was not the main concern to them. She was referred by her primary care physician as she complained of impacted ear wax. However, rhinolith was incidentally found upon routine clinical examination in the ENT clinic and was removed uneventfully.
    Matched MeSH terms: Physicians, Primary Care
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