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Late diagnosis of congenital hypothyroidism : the case for newborn screening

Tan, Kah Kee, Kaur, Pyar

Malaysian Journal of Child Health, 1994;6(1):36-39.
MyJurnal

26 cases of congenital hypothyroidism were diagnosed at the Penang General Hospital from 1979 to 1993. Therewere 19 femalesand7males, thefemaletomaleratiowas2 .7 : 1. All three main ethnic groups were almost equally afflicted (10 Chinese,8Malays,8 Indians). The mean age at diagnosis was 15.8 months (range 21 days — 9 years) and only 11 (42.3%) patients were diagnosed within thefirst three months of life. 19 (73.7%) patients were diagnosed within thefirstyear and 7 (26.3%) after the firstyear. The correct referral diagnosis was made in less than half (n = 11) of the patients, with a mean of 2.3 doctors being consulted prior to the diagnosis. The five most common clinical features were coarse facies (n = 22), dry skin (n = 22), macroglossia (n = 21), lethargy (n = 20) and constipation (n = 19). The develop-ment quotient was appropriate for chronologi-cal age in less than one third (n = 8) of patients while the school performance was at least average in only less than one third (n = 5) of school-goers (n = 16). The mean (SD) T4 at diagnosis was 23.7 (12.2) nmollL while the mean (SD) TSH at diagnosis was 72.7 (37.0) mUIL. In the light of these clinical findings, screening for congenital hypothyroidism with a view to early diagnosis and prompt treatment are strongly recommended.

Matched MeSH terms: Hospitals, General
Conduct disorders seen in child psychiatric outpatient clinic, Hospital Kuala Lumpur

Loh, C.C., Mohd Amin, S., Kasmini, K.

Malaysian Journal of Child Health, 1994;6(1):12-17.
MyJurnal

This is a retrospective and descriptive study of 30 children and adolescents with conduct disorders diagnosed for the first time this year (1993) at the Child and Family Consultation Unit, UKM. Eleven of them were diagnosed to have a Socialized Conduct Disorder, 8 had symptoms of Unsocialized Conduct Disorder, whilst 4 had Conduct Disorder confined to the family context. Another 5 had Depressive Conduct Disorders while 2 had features of other mixed disorders of conduct and emotions. Most them were boys and were ten years old and above. The majority presented with at least one year history of illness and school authorities played an important role in being the main referral agency. Prominent abnormal psychosocial situations were inadequate or inconsistent parental control and discordant intro familial relationships. Socio-economic status and geographical differences were associated with the prevalence of the disorder. The main symptomatology found were disobedience and frequent lying, stealing, truancy and fighting or bullying.

Study site: outpatient clinic, Hospital Kuala Lumpur

Matched MeSH terms: Hospitals, General
Fulltext Case series analysis of oral cancer and their risk factors

Khan, A.R., Anwar, N., Manan, A.H.B., Narayan, K.A.

Malaysian Dental Journal, 2008;29(1):46-50.
MyJurnal

Cancer causes approximately 12% of all deaths throughout the world and is the third leading cause of death in developing countries. In Malaysia, Indians have the highest incidence of mouth cancer compared to other races, and females are more affected compared to males.
Objective: The main objective of this study was to analyze the cases of oral cancer treated in the dental department of Penang hospital, Malaysia and to determine the risk factors associated with oral cancer.

Methodology: We reviewed the medical reports of all the patients with oral cancer treated in the dental department of Penang General Hospital from 1994 to 2004.

Results: There were 46 cases of oral cancer treated by the dental department of Penang General Hospital during this time period. 22 were males and 24 females. The mean age of the patients was 61.2 years old. Indians comprised the majority of the cases (n=23; 50%) followed by Malays (n=12; 26.1%) and Chinese (n=11; 23.9%). Of these cases, 54.3% (n=25) had used quid, 39.1% (n=18) smoked cigarettes and 32.6% (n=15) consumed alcohol. Indians made up 76% (n=19) of all quid users (p=

Matched MeSH terms: Hospitals, General
Fulltext The effect of diet control on the leptin levels in diabetic pregnant women

Muna KA, Mokhtar A, Saad MA, Ahmed AA, Akbar JB

International Medical Journal Malaysia, 2015;14(1):59-63.
MyJurnal

Introduction: Leptin is an adipokine that has strong correlation with the body mass index (BMI). Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. Leptin may lose its correlation with the body mass index (BMI) during diabetes due to hormonal rearrangement. Diet control is the first line management in GDM. Leptin reported to increase in pregnancy and further increases in diabetic patients during GDM screening. There is paucity in the reports concerning Leptin levels in GDM patients on diet control. The present study was aimed to evaluate the changes in maternal leptin in pregnancy complicated by GDM on diet control compared to the normal pregnancy in the 3rd trimesters by comparing the means and to find the correlation of Leptin with the body mass index in both groups.
Methods: The study included 2 groups: normal pregnancy (n = 40) and pregnancy with GDM under diet control (n = 60) both groups are at 38-40 weeks of gestation. Leptin concentration in serum was measured in both groups and statistically tested using student t test. The BMI were measured and correlated with the Leptin level in test groups.
Results: the results indicated that Leptin will nearly triple in the third trimester (38±30 ng/ml) of pregnancy compared to the standard normal non-pregnant. Leptin level was significantly lower in diabetic women on diet control (28±16 ng/ ml) when compared with the non-diabetics (38±30 ng/ml). The hormone has no correlation with the age of the patients but have a positive correlation with the body mass index before and during pregnancy in both groups.
Conclusion: Leptin is increasing in pregnancy as part of the physiological changes. Dieting can decrease Leptin level in diabetics’ pregnant women. Diet can restore the hormonal dysregulation of Leptin. Assessment of Leptin level might be used as an indicator for good diet control during pregnancy.
Study site: Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia

Matched MeSH terms: Hospitals, General
Fulltext Plasma level as marker for early detection of heart failure in primary hypertensive patients

Norsham J, Azmani SM, Roslan H, Latiff MA

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):13-19.
MyJurnal

Heart failure is chiefly the end stage of primary hypertension and a major public health problem in Malaysia. The aim of this work is to investigate the level of BNP that may discriminate between primary hypertension patients without heart failure and primary hypertensive patients with heart failure. This study was conducted on 60 hypertensive patients without any clinical symptoms of heart failure referred for echocardiography to evaluate the ventricular function. Patients with metabolic diseases and terminal diseases were excluded from the study. The BNP levels were assessed using the Triage Meter from Biosite Diagnostics. Results showed that BNP level display a negative correlation with ejection fraction (Pearson correlation test). The significant result (paired t test, p < 0.05) proves that both predictors are very important and relates to each other. Low ejection fraction is significantly marked with raised BNP level suggesting that BNP may play potential role as screening tool for early detection of heart failure in primary hypertensive patients.

Study site: (Universiti Kebangsaan
Malaysia Medical Center and International Medical University cardiology clinic, Seremban

Matched MeSH terms: Hospitals, General
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
Fulltext Asthma control in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: a cross-sectional study

Kuan YC, Tan CH, Hong CM, How SH

International Medical Journal Malaysia, 2015;14(2):41-44.
MyJurnal

Introduction: Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital.
Methods: A cross-sectional study of all patients with bronchial asthma who attended the Chest Clinic at Hospital Tengku Ampuan Afzan (HTAA) from 2009 to 2011. Patient demographics, self-administered ACT scores, GINA-defined level of asthma control and medications were documented.
Results: 208 patients were recruited. There were 23.2%, 46.3% and 30.5% of patients with controlled, partly controlled and uncontrolled asthma respectively. The median ACT scores was 19 [inter quartile range (IQR) 6]. The most frequently used preventer therapy was inhaled long-acting β-agonist/corticosteroids (LABA/ICS) fixed-dose combination (61.7%), and 9.6% were not on preventer therapy. 75% of patients with controlled asthma were on LABA/ICS compared to 58.5% of the partly controlled and uncontrolled groups (p=0.039).
Conclusion: The majority of the asthmatic patients attending the Chest Clinic at HTAA did not have GINA-defined controlled asthma. Patients with higher ACT scores had better control of asthma. There were more patients with controlled asthma who were on LABA/ICS combination.
KEYWORDS: Bronchial asthma, level of control, Asthma Control Test
Study site: Chest Clinic, Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia
Device, Questionnaire & Scale: Asthma Control Test (ACT)

Matched MeSH terms: Hospitals, General
Fulltext Gaining insight into patients’ experience of adherence to hypertensive treatment

Lee, K., Yunus, M., Loong, Y. Y., Shamsuddin, A., Zubaidah, J., Rosna, A. R.

Malaysian Journal of Medicine and Health Sciences, 2010;6(2):43-50.
MyJurnal

Hypertension is one of the major risk factors for coronary heart disease and the most important factor for cerebrovascular diseases. Adherence to treatment is a fundamental pre-requisite for therapeutic benefit in hypertensive patients. Adherence is a complex behavioural process that is strongly influenced by the way in which patients live, as well as the psychological and social support system.
Aim: To understand and conceptualize the experience of people on long-term antihypertensive treatment Method: Qualitative analysis using semi-structured interviews with ten hypertensive patients from the medical clinic of Kuala Lumpur General Hospital.
Results: Although the participants were aware of having high blood pressure they declined receiving any treatment at the early stage of the disease. Fear of death and disease complications are reinforcements for participants to adhere to medication. They perceived the label of “hypertension” will affect their self-identity and social role. Positive thinking regarding medication assists participants to adhere to treatment. Conversely, participants who perceived medication negatively also adhere to a medication regime, as adherence behaviour satisfies the family. Participants justified modifying their regimen or taking Complementary and Alternative Medicine (CAM) as they believe know the their body best. However, participants wished to obtain more information regarding hypertension and its treatment from the doctors.
Conclusion: In finding the fine balance between stepping in and holding back treatment and care, health professionals need to know their clients in context. This balance can only be achieved by establishing processes of negotiation within an ongoing therapeutic relationship.

Study site: medical clinic of Kuala Lumpur General Hospital.

Matched MeSH terms: Hospitals, General
Fulltext Caregiving for epilepsy: awareness, knowledge, attitude, and health-related quality of family caregivers

Lua, P.L., Nor-Khaira-Wahida, K., Zariah, A.A., Lee K.F.

Malaysian Journal of Psychiatry, 2014;23(1):45-56.
MyJurnal

Living with epilepsy is equally demanding for both patients and their caregivers. The caregivers’ tasks are not limited to caring for the patients only but also the need to improve their awareness, knowledge and attitude (AKA) level as lack of understanding has a major impact on health-related quality of life (HRQoL). Little is known about the influence of AKA on family caregivers’ HRQoL. Objective: Therefore, this study aimed to assess and relate the AKA and HRQoL profiles of epilepsy carers. Methods: This prospective, cross-sectional study included a sample of 32 epilepsy family caregivers who were recruited from the Neurology and Paediatric Clinics of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. Results: Majority were Muslims (93.8%), married (65.6%), housewives (31.2%), who earning monthly income of not more than RM 1000 (34.4%) and was the patients’ mothers (40.6%). The Total AKA score was generally good (mean=123.4±16.8, median 122.5) with awareness being good, knowledge moderate and attitude positive whereas HRQoL score for Disruptiveness was the highest (good) compared to other domains. There were significantly higher scores for Sexual Functioning (p = 0.039) among Poor AKA group and Pain Management (p = 0.040) among Good AKA. Conclusion: The overall outcomes signified that family caregivers with Good AKA experienced better well-being compared to those with Poor AKA while carrying out their roles as caregivers. Consequently, carers clearly require constant epilepsy education to enhance skill-building in order to understand and keep updates with the disease, thus indirectly sustaining their desired HRQoL status from time to time.

Study site: Neurology and Paediatric Clinics of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu

Matched MeSH terms: Hospitals, General
Fulltext Prevalence and associated factors of stress, anxiety and depression among emergency medical officers in Malaysian hospitals

Yahaya SN, Wahab SFA, Yusoff MSB, Yasin MAM, Rahman MAA

World J Emerg Med, 2018;9(3):178-186.
PMID: 29796141 DOI: 10.5847/wjem.j.1920-8642.2018.03.003

BACKGROUND: Demanding profession has been associated with poor psychological health due to multiple factors such as overworking hours and night shifts. This study is to determine prevalence and associated factors of depression, anxiety and stress among medical officers working at emergency department in Malaysian hospitals.
METHODS: A cross-sectional study was conducted on 140 emergency department medical officers working at general hospitals from seven Malaysia regions. They were randomly selected and their depression, anxiety and stress level were measured by the 21-item Depression, Anxiety, Stress Scale.
RESULTS: The highest prevalence was anxiety (28.6%) followed by depression (10.7%) and stress (7.9%). Depression, anxiety and stress between seven hospitals were not significantly different (P>0.05). Male medical officers significantly experienced more anxiety symptoms than female medical officers (P=0.0022), however depression and stress symptoms between male and female medical officers were not significantly different (P>0.05). Depression, anxiety and stress were not associated with age, working experience, ethnicity, marital status, number of shifts and type of system adopted in different hospitals (P>0.05).
CONCLUSION: The prevalence of anxiety was high, whereas for depression and stress were considerably low. Gender was the only factor significantly associated with anxiety. Other factors were not associated with depression, anxiety and stress. Future research should aim to gain better understanding on unique factors that affect female and male medical officers' anxiety level in emergency setting, thus guide authorities to chart strategic plans to remedy this condition.

Matched MeSH terms: Hospitals, General
Quality of life among Patients with Acute Coronary Syndrome in Malaysia

Azmi S, Goh A, Fong A, Anchah L

Value Health Reg Issues, 2015 May;6:80-83.
PMID: 29698198 DOI: 10.1016/j.vhri.2015.03.015

OBJECTIVES: This study's objectives were to estimate the quality of life (QOL) of Malaysian patients with acute coronary syndrome (ACS) during admission and at 12 months, to explore the factors associated with the QOL, and to compare utility scores derived from tariffs from local and foreign populations.
METHODS: Data collected from patients with ACS between 2008 and 2009 for a study on cardiac rehabilitation at the Sarawak General Hospital were used for this study. QOL data were obtained using a validated version of the EuroQol five-dimensional questionnaire at baseline and at 12 months. Health utility scores were calculated using visual analogue scale scores and utility tariffs from Malaysia and the United Kingdom.
RESULTS: Data from 104 subjects from the earlier study was used. The mean age was 56.1 years, with 88.5% being men. The mean hospitalization duration was 6.3 days. The mean utility score was 0.75 at baseline and 0.82 at 12 months. There was a statistically significant improvement in utility from baseline to 12 months based on the Malaysian tariff (P = 0.014) but not with the UK tariff (P = 0.086). The QOL of patients was associated with sex and diagnosis of ST-segment elevation myocardial infarction.
CONCLUSIONS: Our results showed that there was a significant improvement in the QOL from baseline to 12 months. Only sex and diagnosis affected the QOL score at baseline because of limited variables available for testing. It also reconfirms the importance of applying the appropriate, country-specific utility tariffs in QOL studies. Despite limitations, the study is useful toward describing QOL among a group of Malaysian patients with ACS.

Matched MeSH terms: Hospitals, General
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
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
Fulltext Prevalence and levels of burnout among nurses in Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan

Mustaffa Z, Chan SG

The Malaysian Journal of Nursing, 2015;7(1):7-11.
MyJurnal

The main objective of this study is to evaluate the nurses' level of burnout and identify the factors that influence it. Burnout, one such stress-related outcome, has been conceptualised as a multidimensional construct consisting of emotional exhaustion, depersonalisation and reduced personal accomplishment. Items adapted and translated from Maslach Burnout Inventory were used to collect data from 60 respondents. Among the respondents, 5.0% showed a high level of Emotional Exhaustion while 95.0% were at the moderate and mild level. Respondents with a high level of Depersonalization constitute 3.3% while 96.7% were at a moderate and mild level. Analysis show that 48.2% are at the high and moderate level for Personal Accomplishment while 51.7% is still at the lower level. Mean score for Personal Accomplishment 33.53 as oppose to Emotional Exhaustion 15.90 and Depersonalization 3.60 indicate a low level of burnout characteristic among the staff nurses. Correlation analysis suggest a significant but moderate relationship between Emotional Exhaustion and Depersonalization r = 0.62, p<0.05. A conducive working environment was suggested as a way of improving quality of health care and to hinder burnout. Keywords: Retirement, Readiness, Financial Capacity, Social Support, Preoccupation

Matched MeSH terms: Hospitals, General
Spirituality Needs in Chronic Pain Patients: A Cross-Sectional Study in a General Hospital in Malaysia

Ganasegeran K, Abdulrahman SA, Al-Dubai SAR, Tham SW, Perumal M

J Relig Health, 2020 Jun;59(3):1201-1216.
PMID: 30406891 DOI: 10.1007/s10943-018-0730-z

Evidence-based practices that rely upon pain relieving medications and interventional strategies for symptom alleviation in chronic pain survivors have shown modest benefits. The recent emphasis of spiritual care as a new dimension of treatment strategy incorporated within the biopsychosocial model has inspired new hopes to mediate mental and physical health for illness coping. This study aimed to explore the factors associated with spirituality needs among chronic pain patients in a general hospital in Malaysia. An analytical cross-sectional study was conducted among 117 chronic pain patients in a general hospital in Malaysia. Clinical features and assessments were evaluated by an experienced pain physician and retrieved from patient medical records. An interviewer-administered questionnaire that consisted of items on socio-demographics, the validated 19-items spiritual needs questionnaire and the visual analog scale was utilized. Multivariate linear regression analysis was conducted to identify the factors associated with spiritual needs in chronic pain patients. Patients had higher actively giving score as compared to other spirituality need domains. Central neuropathic pain (β = 1.691, p = 0.040) predicted existential. Renal problems (β = 5.061, p = 0.019) highly predicted religiosity; followed by head pain (β = 3.774, p = 0.036), central neuropathic pain (β = 2.730, p = 0.022), heart problems (β = 1.935, p = 0.041), income (β = 0.001, p = 0.003), living arrangement (β = - 3.045, p = 0.022), face (β = - 3.223, p = 0.005) and abdominal (β = - 4.745, p = 0.0001) pains. Predictors of inner peace include renal problems (β = 3.752, p = 0.021), shoulder pain (β = 1.436, p = 0.038) and pain duration (β = - 0.012, p = 0.027). Predictors of actively giving were renal problems (β = 3.803, p = 0.001), central neuropathic pain (β = 1.448, p = 0.017), heart problems (β = 1.004, p = 0.042), income (β = 0.001, p = 0.0001), age (β = - 0.046, p = 0.004) and abdominal pain (β = - 2.617, p = 0.0001). Chronic pain patients had higher actively giving score compared to other spirituality needs. Their spirituality needs were significantly influenced by pain type, duration and site, co-existing medical conditions and socio-demographics.

Matched MeSH terms: Hospitals, General
Re-evaluation of malnutrition risk screening tool-hospital (MRST-H) for geriatric patients: a multicentre study in Peninsular Malaysia

Tan SL, Sakinah Harith, Hasmah Abdullah, Wan Nazirah Wan Yusuf

Sains Malaysiana, 2016;45:1311-1317.

A local Malnutrition Risk Screening Tool-Hospital (MRST-H) has been developed to identify the risk of malnutrition among hospitalized geriatric patients in Malaysia. The aims of this multicenter study were to evaluate the criterion validity of the MRST-H against the reference standard Subjective Global Assessment (SGA) and revise its scoring criteria among Malaysian geriatric patients. A cross-sectional study was conducted among 542 geriatric patients at eight general hospitals in Peninsular Malaysia from January 2011 to February 2013. The Malay version MRST-H and SGA were administered to all participants through face-to-face interviews. Sensitivity and specificity of MRST-H were established using the Receiver Operating Characteristic (ROC) curves and the optimal cut-off scores were determined. The MRST-H had area under the ROC curve (AUC) values of 0.84 and 0.88 when validated against the SGA-determined malnutrition (SGA B+C) and severe malnutrition (SGA C) status. These high AUC values indicated that the MRST-H has very good overall diagnostic accuracy. However, the original cut-off score of five points for MRST-H has undesirable sensitivity in identifying the malnutrition (sensitivity = 0.12) and severely malnutrition (sensitivity = 0.35) status. The optimal cut-off score of MRST-H in identifying malnourished and severely malnourished participants were both established at the cut-off score of two points. The sensitivity of MRST-H increased substantially at this point without compromising its specificity. Therefore, the established cut-off score of two points with optimal sensitivity and specificity was selected to replace to original cut-off score for screening of risk of malnutrition among hospitalized geriatric patients.

Matched MeSH terms: Hospitals, General
Fulltext History of falls and its relationship with nutritional status among elderly patients. [Sejarah jatuh dan hubungannya dengan status pemakanan di kalangan pesakit warga tua]

Cheng SH, Shahar S, Lee FS, Ramli A

Sains Malaysiana, 2012;41:379-385.

Rising risk of falls has been associated with injury and dysfunction among the elderly. Therefore, this study was conducted to determine the prevalence of falls and association with nutritional status among 143 elderly patients from medical ward and clinic in Hospital Kuala Lumpur. Anthropometric indicators and bone health status using quantitative ultrasound (QUS) were also assessed. History of falls, functional status and dietary intake based on dietary history was assessed
through questionnaire which was administered by face-to-face interview with the subjects. Data were analyzed using SPSS software version 16.0 and Foodworks. The past-year prevalence of falls (falls at least once in the previous 12 months) in this study was 32.9%. The past year prevalence of falls in women (40.2%) was higher than in men (17.4%) (p<0.01). Women who had calcium intake less than 300 mg/d (adjusted OR = 3.07, 95% CI = 1.02-9.24) and protein intake < 1 g/kg body weight (adjusted OR = 3.68, 95% CI = 0.98-13.84) were more likely to have a higher risk of falls. In conclusion, one third of the subjects, especially women in this study had a history of falls. Elderly people should be assessed for calcium and protein intake and those with calcium intake less than 300 mg/day and protein intake less than 1 g/kg body weight should be given intervention to reduce falls risk factor and subsequent fall-related co-morbidity.
Keywords: Elderly patients; falls; nutritional status

Matched MeSH terms: Hospitals, General
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
Fulltext The Autonomic Progress Bar Motivates Treatment Completion for Patients of Stimulant Use Disorder and Cannabis Use Disorder

Chen IC, Teng G, Chen CJ, Lan TH, Liu HJ

Front Psychiatry, 2019;10:944.
PMID: 31998160 DOI: 10.3389/fpsyt.2019.00944

Background: The intrinsic motivation behind the "need to complete" is more influential than external incentives. We introduced a novel progress-bar tool to motivate the completion of programs designed to treat stimulant and cannabis use disorders. We further examined the effectiveness of the progress bar's scoring approach in forecasting consistently negative urine tests. Methods: This study's participants included 568 patients with stimulant, amphetamine-type, and cannabis use disorders who were undergoing 12-month mandatory treatment programs at Taichung Veterans General Hospital in Taiwan. Patients were given scores of 1, -1, or 0 depending on whether they received negative, positive, or missing urinalysis reports, respectively. The autonomic progress bar generated weekly score totals. At the group level, scorei donated scores from all patients for a given week (i denoted the week). Scorei was standardized to adjusted scorei. We then conducted Autoregressive Integrated Moving Average (ARIMA) Model of time-series analyses for the adjusted scorei. Results: A total of 312 patients maintained treatment progress over the 12-month program. The autonomic score calculator totaled the shared achievements of these patients. The coefficients of the lag variables for mean (p), lag variables for residual error term (q), and number of orders for ensuring stationary (d) were estimated at p = 3, d = 4, and q = 7 for the first half of the treatment program, and were estimated at p = 2, d = 2, and q = 3 for the second half. Both models were stationary and tested as fit for prediction (p < 0.05). Sharply raised adjusted scores were predicted during the high-demand treatment phase. Discussion: This study's novel progress-bar tool effectively motivated treatment completion. It was also effective in forecasting continually negative urine tests. The tool's free open-source code makes it easy to implement among many substance-treatment services.

Matched MeSH terms: Hospitals, General
Fulltext Knowledge and practice among patients with diabetic foot complications in orthopaedic department in Kuala Lumpur hospital

Thair Mousa, Ebrahim, Jalal, Hasanain Faisal Ghazi, Elnajeh, Maged

Journal of Management & Science, 2017;15(1):39-44.
MyJurnal

Diabetes mellitus is a silent disease and is now recognized as one of the fastest growing threats to public death in almost all countries of the world. One of the important complications of diabetes mellitus is the foot related complications. Diabetic foot is the most common cause of hospitalization in diabetic patient. Increase the knowledge and awareness of Diabetic foot complication in diabetic patient could be one of the preventable measures. The aim of this study is to assess the level of knowledge and practice regarding foot care among patients with diabetic foot complications. A cross-sectional study performed on patients who attended the diabetic foot clinic and for those admitted for diabetic foot complications from the 1st September 2015 to 25th September 2015. The patients were interviewed with a questionnaire of 15 ‘yes’ or ‘no’ questions, on foot care knowledge and practice. Score of 1 was given for each ‘yes’ answer and 0 for a ‘no’ answer. The level of knowledge and practice were categorized into good, satisfactory or poor. The result was tested using chi-square in SPSS version 21. A total of 150 patients were included in this study. There were 75 male (50.0%) and 75 female (50.0%) with the majority of patients were over 55 years old (113 patients, 75.3%). Majority of the patients (64.0%) had poor foot care knowledge while 75 patients (50.0%) had poor foot care practice. In conclusion, based on our cross-sectional study that was done, most diabetic patients still have poor knowledge and practice regarding their diabetic foot care. Educational strategies regarding foot care should be emphasized and empowered within the diabetic population.

Matched MeSH terms: Hospitals, General

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