OBJECTIVE: To measure factors associated with mHealth adoption among primary care physicians (PCPs) in Malaysia.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted among PCPs. The usage of mHealth apps by the PCPs has divided into the use of mHealth apps to support PCPs' clinical work and recommendation of mHealth apps for patient's use. Factors associated with mHealth adoption were analysed using multivariable logistic regression.
RESULTS: Among 217 PCPs in the study, 77.0% used mHealth apps frequently for medical references, 78.3% medical calculation and 30.9% interacting with electronic health records (EHRs). Only 22.1% of PCPs frequently recommended mHealth apps to patients for tracking health information, 22.1% patient education and 14.3% use as a medical device. Performance expectancy and facilitating conditions were associated with mHealth use for medical references. Family medicine trainees, working in a government practice and performance expectancy were the facilitators for the use of mHealth apps for medical calculation. Internet connectivity, performance expectancy and use by colleagues were associated with the use of mHealth with EHR. Performance expectancy was associated with mHealth apps' recommendation to patients to track health information and provide patient education.
CONCLUSIONS: PCPs often used mHealth apps to support their clinical work but seldom recommended mHealth apps to their patients. Training for PCPs is needed on the appraisal and knowledge of the mHealth apps for patient use.
Objectives: We aimed to systematically produce empirical evidence on the WPV against health care workers in Africa through the review of relevant literature.
Method: We sourced for evidence through the following databases: PubMed, Science direct and Scopus from 30th November to 31st December 2019 as well as the reference list of the studies included. A total of 22 peer reviewed articles were included in the review (8065 respondents). Quality appraisal of the included studies was assessed using critical appraisal tools for cross-sectional studies.
Result: Across the studies, diverse but high prevalence of WPV ranging from 9% to 100% was reported with the highest in South Africa (54%-100%) and Egypt (59.7%-86.1%). The common types were verbal, physical, sexual harassment and psychological violence. The correlates of WPV reported were gender, age, shift duty, emergency unit, psychiatric unit, nursing, marital status and others. Various impacts were reported including psychological impacts and desire to quit nursing. Patients and their relatives, the coworkers and supervisors were the mostly reported perpetrators of violence. Doctors were mostly implicated in the sexual violence against nurses. Policy on violence and management strategies were non-existent across the studies.
Conclusion: High prevalence of WPV against healthcare workers exists in Africa but there is still paucity of research on the subject matter. However, urgent measures like policy formulation and others must be taken to address the WPV as to avert the impact on the healthcare system.
METHODS: Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions.
RESULTS: After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes, tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families' requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69-9.51, P
METHODS: This study used a descriptive qualitative study design. Interviews were conducted using a semistructured interview guide developed based on the theoretical domains framework. Nine in-depth interviews and three focus group discussions were conducted with patients with type 2 diabetes who have been advised to start insulin or were currently using insulin and those who had been seeking diabetes treatment in the clinic for more than 1 year. Interviews were conducted after the participants were familiarized with the PDA. Data were analysed using a thematic approach.
RESULTS: Five themes emerged from the data analysis: (a) trust in the physician (patients preferred physicians to other health care providers in delivering the insulin PDA to them as they trusted physicians more when it comes to making decisions such as starting insulin), (b) physician's attitude (patients were more likely to trust a physician who is friendly and sympathetic hence would be more willing to use the insulin PDA), (c) physician's communication style (patients were more willing to use the insulin PDA if the physicians would take time and guide them in the PDA use), (d) conducive environment (patients preferred to read the PDA at home), and (e) cost (patients would not be willing to pay to use the insulin PDA unless they needed it).
CONCLUSIONS: Patients want physicians to play a major role in the implementation of the insulin PDA; physicians' communication style and commitment may influence implementation outcomes. Health care authorities need to create a conducive environment and provide patients with free access to PDA to promote effective implementation.
METHODS: A qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data.
RESULTS: Twenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges.
CONCLUSION: Deprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they 'didn't want to rock the boat'. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.
Aim: To evaluate the nephroprotective activity of CAE and its fractions in cisplatin-induced nephrotoxicity and to assess whether they compromise the anticancer efficacy of cisplatin.
Materials and methods: Cisplatin-induced renal damage was induced in Ehrlich Ascites Carcinoma (EAC) bearing mice during mild phase of tumor growth. CAE and its butanol (BF) and aqueous (AF) fractions were administered orally from the 5th day for five days. Nephroprotective potential (serum urea, creatinine, renal histology) and effect of VC on cisplatin anticancer efficacy (tumor volume, viable tumor cells, percentage increase in life span (% ILS)) were calculated.
Result: CAE and its fractions significantly reversed the cisplatin-induced renal damage. CAE and BF treated animals showed regeneration of 50%-75% of proximal tubular cells. Compared to EAC control mice, the % ILS of the cisplatin-treated group was 244% and it was further extended to 379% after CAE administration. The % ILS in the CAE treated group was 1.6 times higher than the cisplatin alone treated group. GC-MS study showed the presence of astaxanthin and betulin.
Conclusion: CAE of VC reverses cisplatin-induced kidney damage as well as regenerates proximal tubular epithelial cells, without compromising the anticancer effect of cisplatin. When CAE was further fractionated, the nephroprotective activity was retained, but the beneficial anticancer effect of cisplatin was compromised.
METHODS: A questionnaire survey was conducted among general surgeons attending the annual Malaysian College of Surgeons meeting in 2002. A total of 110 questionnaires were distributed to specialist-grade general surgeons with varying subspecialty interests.
RESULTS: Seventy-seven (70%) surgeons returned the questionnaire. Of these, 43% were of the opinion that VTE was as common in Asian patients as in the West. Selective VTE prophylaxis was used by 99% in their practice. The indications for use, in order of frequency, were: previous VTE disease, risk grading, prolonged surgery, obesity, malignancy and age. Low molecular weight heparin was the most common type of prophylaxis used. VTE-related morbidity was reported by 44 surgeons (57%) over the past year, and 39% of these cases were fatal.
CONCLUSION: The high incidence of VTE-related complications indicates that the use of thromboprophylaxis is either insufficient or not matched to the level of risk. Updated guidelines on VTE prophylaxis should be used so that a standardized approach can ensure that patients receive adequate prophylaxis where indicated.