Displaying publications 421 - 440 of 838 in total

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  1. Are essential medicines in Malaysia accessible, affordable and available?
    Saleh K, Ibrahim MI
    Pharm World Sci, 2005 Dec;27(6):442-6.
    PMID: 16341951 DOI: 10.1007/s11096-005-1318-8
    OBJECTIVE: To assess the pharmaceutical sector to know whether people have access to essential medicines.

    SETTING: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory).

    METHOD: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies.

    MAIN OUTCOME MEASURE: Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines.

    RESULTS: The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary.

    CONCLUSIONS: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.
    Matched MeSH terms: Ambulatory Care Facilities
  2. Fulltext Audit of diabetes mellitus in general practice
    Lee TW, Chan SC, Chua WT, Harbinder K, Khoo YL, Ow Yeang YL, et al.
    Med J Malaysia, 2004 Aug;59(3):317-22.
    PMID: 15727376 MyJurnal
    An audit on diabetic management was done in seven Perak general practice (GP) clinics in December 2001. The results showed inadequacies in nine out of eleven criteria assessed. Remedial measures were implemented. A second audit in March 2003, at the completion of the audit cycle, showed improvements in all the criteria used. All clinics established a diabetic register compared to 28.6% in the first audit and 57.1% of the clinics set up a reminder mechanism compared to 0% in the first audit. In the process of care, recording of weight, height, blood pressure; feet examination, fundoscopy, blood sugar monitoring and urine for albumin improved at the end of the audit cycle. In the only outcome criteria, the blood sugar control improved from 21.8% to 31.3%.
    Matched MeSH terms: Ambulatory Care Facilities
  3. Fulltext Metered-dose inhaler technique in asthmatic patients--a revisit of the Malaysian scene
    Loh LC, Teng CL, Teh PN, Koh CN, Vijayasingham P, Thayaparan T
    Med J Malaysia, 2004 Aug;59(3):335-41.
    PMID: 15727379
    Inefficient metered-dose inhaler (MDI) technique results in poor drug delivery, suboptimal disease control a possibility of inhaled medication overuse. The MDI technique of 134 government hospital and clinic followed-up adult asthmatic patients followed-up in a government hospital and a heath clinic was pragmatically assessed based on the 3 obligatory steps of adequate lip seal, appropriate hand-breath coordination and sufficient breath holding after inhalation. The relationship between technique efficiency and frequency of daily short-acting beta2-agonist (SABA) use via the MDI and asthma exacerbations over a 12-month period was also assessed. Fifty-six patients (42%) had inefficient MDI technique. All demographic and asthma-related variables between the 'efficient' and 'inefficient' technique groups of patients were comparable except for significantly longer mean years of MDI use in the 'efficient' technique group [mean (SD): 10 (7) vs. 7 (5); p=0.003]. There were no significant differences between the two groups in relation to frequency of daily SABA use or asthma exacerbations over the past 12 months. Despite having been available in Malaysia for a considerable period of time, the MDI device is still poorly handled by a large proportion of adult asthmatic patients. Changing to other more user-friendly devices or use of spacer devices to facilitate delivery should be considered for these patients.
    Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  4. Fulltext Does lifestyle increase the incidence of pregnancy-induced hypertension?
    Adinegara LA, Razzak MS
    Med J Malaysia, 2004 Mar;59(1):39-44.
    PMID: 15535334
    A case-control study was carried out in Alor Gajah to determine the socio-economic, dietary and lifestyle factors and the occurrence of pregnancy-induced hypertension. There were a total of 30 cases who were selected from antenatal mothers attending 3 selected health centers in 1998. The control group consisted of 30 antenatal mothers who were matched according to health centre, race and age. The results showed that pregnancy-induced hypertension was significantly associated with obesity (P < 0.05) and being a housewife (P < 0.05).
    Matched MeSH terms: Ambulatory Care Facilities
  5. Fulltext What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals' views
    Lee YK, Ng CJ, Lee PY, Khoo EM, Abdullah KL, Low WY, et al.
    Patient Prefer Adherence, 2013;7:103-9.
    PMID: 23378747 DOI: 10.2147/PPA.S36791
    BACKGROUND: Patients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies.
    OBJECTIVE: This study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.
    METHODS: Semi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.
    RESULTS: FIVE THEMES WERE IDENTIFIED AS BARRIERS: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments.
    CONCLUSION: This study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.
    KEYWORDS: diabetes; focus groups; insulin; noncommunicable disease; primary care; qualitative study
    Matched MeSH terms: Ambulatory Care Facilities
  6. Fulltext Primary care doctors' perceptions towards evidence-based medicine in Melaka State: a questionnaire study
    Chan GC, Teng CL
    Med J Malaysia, 2005 Jun;60(2):130-3.
    PMID: 16114151
    A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conclucted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.
    Matched MeSH terms: Ambulatory Care Facilities
  7. Fulltext Audits in general practice by medical students
    Chan SC
    Med J Malaysia, 2004 Dec;59(5):609-16.
    PMID: 15889563 MyJurnal
    This paper reports the implementation, findings and feedback of the audit project of the general practice (GP) module carried out in the fifth year of the MBChB (Sheffield) twinning programme with the Perak College of Medicine. After training, each student with his/her GP tutor planned and conducted the audit. All 28 students (year 2002) satisfactorily completed their audit projects. Fifty percent did an audit of hypertension, 36% on diabetes, 7% on asthma and one each (3.5%) on upper respiratory tract infection and client satisfaction. It was the GP tutors first experience at audit in their clinics. The majority of indicators of care audited did not meet the set target standards.
    Matched MeSH terms: Ambulatory Care Facilities
  8. Fulltext Use of chronic kidney disease to enhance prediction of cardiovascular risk in those at medium risk
    Chia YC, Lim HM, Ching SM
    PLoS One, 2015;10(10):e0141344.
    PMID: 26496190 DOI: 10.1371/journal.pone.0141344
    Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998-2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated.
    Matched MeSH terms: Ambulatory Care Facilities
  9. Fulltext Rural doctors' views on and experiences with evidence-based medicine: The FrEEDoM qualitative study
    Hisham R, Liew SM, Ng CJ, Mohd Nor K, Osman IF, Ho GJ, et al.
    PLoS One, 2016;11(3):e0152649.
    PMID: 27031700 DOI: 10.1371/journal.pone.0152649
    BACKGROUND: Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice.
    AIM: This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting.
    METHODS: Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach.
    RESULTS: Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings.
    CONCLUSION: The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.
    Study site: Klinik Kesihatan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  10. Fulltext Views and experiences of Malaysian older persons about falls and their prevention-A qualitative study
    Loganathan A, Ng CJ, Low WY
    BMC Geriatr, 2016;16:97.
    PMID: 27153989 DOI: 10.1186/s12877-016-0274-6
    BACKGROUND: Few studies on falls interventions have been conducted in South East Asia. Despite its population ageing rapidly, the acceptability of interventions among the older population in this region remains variable. This study aims to explore views and experiences regarding falls and their prevention among older persons at high risk of falls.
    METHOD: Sixteen individuals aged 60 years and over with at least one fall in the preceding 12 months were recruited from our Primary Care clinics. A qualitative study using semi-structured interviews among individuals and focus-groups was conducted. Thematic analyses were conducted on transcriptions of audio-taped interviews using the WeftQDA software. The interviews ceased when data saturation was achieved.
    RESULTS: The three themes included older persons' views on falls, help-seeking behaviour and views on falls interventions. Many older persons interviewed did not perceive falls as a serious problem, some reported a stigma surrounding falls, while others felt they had not sustained more serious injuries due to God's grace. Older persons sought traditional medicine and other alternative treatments for pain relief and other fall-related symptoms. Accessibility of healthcare facilities often prevented older persons from receiving physiotherapy or eye tests.
    CONCLUSION: The delivery of complex interventions for a multifactorial condition such as falls in the older persons in our setting is inhibited by various cultural barriers, falls perceptions as well as logistic difficulties. Efforts to establish a multi-disciplinary intervention among our older population will need to include strategies to overcome these issues.
    KEYWORDS: Accidental falls; Aged; Falls interventions; Falls preventions; Older adults; Qualitative study

    Study site: Primary Care Clinics at University of Malaya Medical Centre (UMMC)
    Matched MeSH terms: Ambulatory Care Facilities
  11. Pre-pregnancy body mass index, height and physical activity are associated with rate of gestational weight gain among Malaysian mothers
    Yong HY, Mohd Shariff Z, Koo SJ, Binti Sa'ari NS
    J Obstet Gynaecol Res, 2016 Sep;42(9):1094-101.
    PMID: 27226139 DOI: 10.1111/jog.13039
    AIM: Both inadequate and excessive weight gain during pregnancy can have immediate and long-term health risks for women and infants. This study investigated rate of gestational weight gain (GWG) and its associated factors in Malaysian pregnant women.
    METHODS: This cross-sectional study was conducted at maternal and child health clinics in Selangor and Negeri Sembilan between November 2010 and April 2012. A pre-tested questionnaire was used to obtain sociodemographic, obstetric, dietary intake and physical activity information. Current weight and height were measured using standard procedures. GWG rate was calculated as the average weekly weight gain in that particular trimester of pregnancy and further categorized according to the Institute of Medicine (IOM) recommendations.
    RESULTS: Mean GWG rate for all pre-pregnancy BMI categories in the second and third trimesters was higher than the IOM recommendations. Overweight women (adjusted OR, 4.26; 95%CI: 1.92-9.44) and women <153 cm tall (adjusted OR, 1.96; 95%CI: 1.21-3.18) tend to have inadequate GWG rate. Women with high pre-pregnancy body mass index (BMI; ≥25.0 kg/m(2) ; overweight: adjusted OR, 3.88; 95%CI: 2.12-7.09; obese: adjusted OR, 2.34; 95%CI: 1.28-4.29) and low physical activity (adjusted OR, 1.74; 95%CI: 0.77-3.97) were two-threefold more likely to have excessive GWG.
    CONCLUSION: Both inadequate and excessive GWG can have detrimental effects on the health of mothers and infants. Pre-pregnancy BMI, height and physical activity should be emphasized in prenatal care to ensure that women have adequate GWG rate.
    Study site: maternal and child health clinics (Klinik Kesihatan), Selangor and Negeri Sembilan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  12. Fulltext Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study
    Butt M, Mhd Ali A, Bakry MM, Mustafa N
    Saudi Pharm J, 2016 Jan;24(1):40-8.
    PMID: 26903767 DOI: 10.1016/j.jsps.2015.02.023
    Malaysia is situated in Western Pacific region which bears 36.17% of total diabetes mellitus population. Pharmacist led diabetes interventions have been shown to improve the clinical outcomes amongst diabetes patients in various parts of the world. Despite high prevalence of disease in this region there is a lack of reported intervention outcomes from this region. The aim of this study was to evaluate the impact of a pharmacist led intervention on HbA1c, medication adherence, quality of life and other secondary outcomes amongst type 2 diabetes patients.

    METHOD: Type 2 diabetes mellitus patients (n = 73) attending endocrine clinic at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were randomised to either control (n = 36) or intervention group (n = 37) after screening. Patients in the intervention group received an intervention from a pharmacist during the enrolment, after three and six months of the enrolment. Outcome measures such as HbA1c, BMI, lipid profile, Morisky scores and quality of life (QoL) scores were assessed at the enrolment and after 6 months of the study in both groups. Patients in the control group did not undergo intervention or educational module other than the standard care at UKMMC.

    RESULTS: HbA1c values reduced significantly from 9.66% to 8.47% (P = 0.001) in the intervention group. However, no significant changes were noted in the control group (9.64-9.26%, P = 0.14). BMI values showed significant reduction in the intervention group (29.34-28.92 kg/m(2); P = 0.03) and lipid profiles were unchanged in both groups. Morisky adherence scores significantly increased from 5.83 to 6.77 (P = 0.02) in the intervention group; however, no significant change was observed in the control group (5.95-5.98, P = 0.85). QoL profiles produced mixed results.

    CONCLUSION: This randomised controlled study provides evidence about favourable impact of a pharmacist led diabetes intervention programme on HbA1c, medication adherence and QoL scores amongst type 2 diabetes patients at UKMMC, Malaysia.

    Matched MeSH terms: Ambulatory Care Facilities
  13. Fulltext Personal continuity of care in a university-based primary care practice: impact on blood pressure control
    Hanafi NS, Abdullah A, Lee PY, Liew SM, Chia YC, Khoo EM
    PLoS One, 2015;10(7):e0134030.
    PMID: 26214304 DOI: 10.1371/journal.pone.0134030
    Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP) control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4) was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI), which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients' mean age was 62.0 years (SD 10.4). The majority was women (59.2%) and married (85.7%). The mean number of visits in a year was 3.85 (SD 1.36). A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff). The mean UPCI was 0.43 (SD 0.34). Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

    Study site: Primary care clinic, University Malaya Medical Centre (UMMC)
    Matched MeSH terms: Ambulatory Care Facilities
  14. Fulltext Mismatch between health-care professionals' and patients' views on a diabetes patient decision aid: a qualitative study
    Lee PY, Khoo EM, Low WY, Lee YK, Abdullah KL, Azmi SA, et al.
    Health Expect, 2016 Apr;19(2):427-36.
    PMID: 25857694 DOI: 10.1111/hex.12366
    BACKGROUND: Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown.
    AIM: We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM).
    DESIGN: We used a qualitative design and thematic approach.
    SETTING: Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices.
    METHOD: We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes.
    RESULTS: We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand.
    CONCLUSION: It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid.
    Matched MeSH terms: Ambulatory Care Facilities
  15. Fulltext Clinical manifestation and risk factors of tuberculosis infection in Malaysia: case study of a community clinic
    Shanmuganathan R, Subramaniam ID
    Glob J Health Sci, 2015;7(4):110-20.
    PMID: 25946947 DOI: 10.5539/gjhs.v7n4p110
    INTRODUCTION: The main aim of this study was to describe the clinical manifestation of tuberculosis infection cases in Malaysia and to determine the individual risk factors for their occurrence.
    METHODOLOGY: The study adopted a quantitative research approach with use of descriptive statistical approach. The study setting was a community clinic which treats walk in patients who are mainly living and working in the surrounding areas. The study was conducted for a period of one year. All tuberculosis patients who sought treatment in the clinic during the time were included in this study. The total number of cases was 40. Data was collected from the medical records of the tuberculosis patients. The risk factors selected for investigation were demographic characteristics of age and sex, personal habits such as smoking, drug use and alcohol and presence of diseases such as human immunodeficiency virus positive (HIV+), diabetes mellitus, cancer, cyanotic heart disease, renal failure and steroid use.
    RESULTS: Patients in the age group ranging from 41 to 50 years had the highest incidence of the infection. Smoking appears to be the most important risk factor for contracting followed by drug abuse, HIV+ infection and diabetes mellitus.
    CONCLUSIONS: People with diseases such as diabetes mellitus and HIV that are high risk factors for TB should be screened for TB so that early detection and intervention is possible. Educational programs should be carried out to create awareness among the at risk groups.
    Matched MeSH terms: Ambulatory Care Facilities
  16. An audit of diabetes-dependent quality of life in patients with type 2 diabetes mellitus in Malaysia
    Jannoo Z, Yap BW, Musa KI, Lazim MA, Hassali MA
    Qual Life Res, 2015 Sep;24(9):2297-302.
    PMID: 25800728 DOI: 10.1007/s11136-015-0969-8
    PURPOSE: The aim of this study was to evaluate and validate the ADDQoL and to assess the impact of diabetes on QoL among the type 2 diabetes mellitus patients in Malaysia.

    METHODS: The Malay and English versions of the ADDQoL questionnaire were administered to patients attending routine outpatient visits in three primary hospitals and a public clinic. The construct validity of the ADDQoL was validated using confirmatory factor analysis (CFA). The sample comprised 350 Malay respondents who rated the ADDQoL Malay version and 246 non-Malay respondents (Chinese or Indian) who answered using the ADDQoL original English version.

    RESULTS: CFA confirmed the presence of one-factor structure for both samples. The internal consistency was high with Cronbach's alpha values of 0.945 and 0.907 for the ADDQoL Malay and English versions, respectively. Results showed that for all three ethnicities, the most important domain is 'family life'. Overall, Malay patients stated their 'living conditions' is the most negatively affected, while for Chinese and Indians, diabetes has the greatest impact on their 'freedom to eat'.

    CONCLUSIONS: The ADDQoL was found to be culturally appropriate, valid and reliable among Malay- and English-speaking type 2 diabetes mellitus patients in Malaysia.

    Study site: routine outpatient visits in three primary hospitals and a public clinic
    Matched MeSH terms: Ambulatory Care Facilities
  17. Fulltext Audit of diabetes in Perak outpatient departments
    Chan SC, Tan OH, Tee AS
    Med J Malaysia, 1997 Dec;52(4):382-9.
    PMID: 10968115
    Adequacy of diabetic management in 5 Perak outpatient departments was studied in April 1996. Two hundred diabetic patients' records were analysed. All doctors and 100 patients answered questionnaires on diabetes. Fifty five percent of doctors had adequate knowledge. Patients' knowledge varied between centres (13% to 80% adequacy). Most records had insufficient data to determine adequacy of early detection. Centres with screeners had adequate weight and blood pressure measurement. Overall control and monitoring of diabetes were inadequate. Referral of complications were delayed in 2 centres. Refresher courses for doctors, patient health education, protocols, screeners and physician visits are recommended.
    Study site: Klinik kesihatan, outpatient clinics, hospitals, Perak, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  18. Fulltext Experience in snuffbox arteriovenous fistulae for hemodialysis
    Lee JK, Sara TT
    Med J Malaysia, 2000 Sep;55 Suppl C:35-8.
    PMID: 11200042
    Sixty-five patients with "Snuffbox" arteriovenous fistulae for hemodialysis were reviewed. The procedure was performed under local anaesthesia as an outpatient procedure. It was done as a "standby" procedure for 41.5% of patients with Chronic Ambulatory Peritoneal Dialysis. 58.5% of patients had the procedure done for primary hemodialysis. Patency was assessed as presence of an engorged vein and presence of thrill. This was assessed routinely at 4 to 6 weeks after the procedure. Patency rate was noted to be 83%. The commonest complication was thrombosis of the arteriovenous anastomosis. Some patients required repeated procedure at a more proximal site. Further study to determine the blood flow rate provided by the anastomosis, and comparison with other anatomical sites is necessary.
    Matched MeSH terms: Ambulatory Care
  19. Fulltext Peak expiratory flow rate in elderly Malaysians
    Srinivas P, Chia YC, Poi PJH, Ebrahim S
    Med J Malaysia, 1999 Mar;54(1):11-21.
    PMID: 10971999
    An epidemiological survey was conducted among 1,414 healthy ambulatory elderly persons aged 55 years and above in the Kuala Langat district, Selangor. The relationship between peak expiratory flow rate (PEFR), demographic variables, socioeconomic status, smoking, alcohol use and respiratory symptoms were examined. The peak expiratory flow declined with age and were lower in women of all ages. Smoking had a modest effect on PEFR in men but not on PEFR in women. The combination of respiratory symptoms of cough, phlegm and wheeze were related to lower PEFR values. Prediction equations are presented derived from the population sample which may be of assistance in assessing observed to expected ratios among elderly people in Malaysia.
    Matched MeSH terms: Ambulatory Care
  20. Utilization of public and private dental services in Sibu, Sarawak: a sociodemographic appraisal and types of treatment received
    Chu GT, Latifah RJ
    Asia Pac J Public Health, 2001;13(2):79-84.
    PMID: 12597503 DOI: 10.1177/101053950101300204
    This study investigated the sociodemographic profiles of patients attending public and private dental clinics and the types of treatment received. Patients (n=454) were interviewed using a structured questionnaire at two public and four private clinics in Sibu District, Sarawak. Generally, Chinese (74.7%), females (60.0%) and urban dwellers (83.7%) were more likely to visit the dentist. Both clinics had more females and more Chinese but private clinics had a lower percentage of female attendees (53.1% versus 67.0%) but a higher percentage of Chinese (85.0% versus 64.5%). Private attendees were younger (mean age of 31.0 years compared to 41.0 years) and from higher income households (median value of MR 2,000 versus MR 900) than public attendees. Treatments were mostly curative and a third of the visits were associated with painful conditions. Age (p=0.006), gender (p=0.003), ethnicity (p<0.001) and household income (p<0.001) were associated with the type of clinic visited. Choice of clinic was not related to having painful conditions (p=0.970). To ensure a more affordable and equitable distribution of oral healthcare, health planners need to identify disparities in the utilization of services and differences between public and private attendees.
    Matched MeSH terms: Ambulatory Care Facilities
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