BACKGROUND: This study was proposed to develop a composite of outcome measures using forced expiratory volume percentage of predicted, exercise capacity and quality of life scores for assessment of chronic obstructive pulmonary disease (COPD) severity.
MATERIALS AND METHODS: Eighty-six patients with COPD were enrolled into a prospective, observational study at the respiratory outpatient clinic, National University Hospital Malaysia (Hospital Universiti Kebangsaan Malaysia--HUKM), Kuala Lumpur.
RESULTS: Our study found modest correlation between the forced expiratory volume in 1 s (FEV(1)), 6 min walk distance and the SGRQ scores with mean (SD) values of 0.97 (0.56) litres/s, 322 (87) m and 43.7 (23.6)%, respectively. K-Means cluster analysis identified four distinct clusters which reached statistical significance which was refined to develop a new cumulative staging system. The SAFE Index score correlated with the number of exacerbations in 2 years (r = 0.497, p<0.001).
CONCLUSION: We have developed the SGRQ, Air-Flow limitation and Exercise tolerance Index (SAFE Index) for the stratification of severity in COPD. This index incorporates the SGRQ score, the FEV(1) % predicted and the 6 min walk distance. The SAFE Index is moderately correlated with the number of disease exacerbations.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
OBJECTIVE: To compare the effectiveness of the Vabra aspirator and the Pipelle device as an outpatient endometrial assessment tool.
METHOD: This was a randomised, prospective trial conducted for a period of one year.
RESULTS: A total of 147 patients were recruited, of which 71 were in the Vabra group and 76 were in the Pipelle arm. The procedure success rate in the Pipelle group was significantly higher than the Vabra arm (98.7 vs 88.7%, P=0.02). Adequate tissue yield was also significantly more in the Pipelle arm (73.3 vs 52.4%, P=0.02). Cost-benefit analysis revealed a higher average cost per patient in the Vabra group compared to the Pipelle arm.
CONCLUSION: This study proved that the Vabra aspirator was not as effective as the Pipelle device in obtaining endometrial tissue for histological diagnosis. Despite its higher price per unit, the Pipelle device was a more cost-effective tool for outpatient endometrial assessment.
Study site: Medical clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia.
Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.
Snoring is considered as the most common clinical symptom of obstructive sleep apnea-hypopnea syndrome. However, many snoring studies were done in western population, and data from around Asia is scarce. Therefore, the purposes of this study were to determine the prevalence of snoring among Malaysian children from hospital-based medical clinic population setting and to compare the craniofacial features of children with and without snoring using cephalometric analysis. A cross-sectional study among children aged 7-15 years were carried out in Hospital Kuala Terengganu. Sleep behavior questionnaire (Berlin questionnaire) was given to 500 children. The respondents were divided into snoring and non-snoring groups. Thirty children from each group were randomly selected to undergo a cephalometric X-ray. For each lateral cephalometric radiograph, 17 parameters consisting bony, soft tissue, and angular measurements were recorded using computer software VixWin2000. Independent t test was used to analyze the data. The results indicated that the whole questionnaire respondents were 317 (46 snoring and 271 non-snoring), hence, the prevalence of snoring in our survey population was 14.51%. The cephalometric X-ray showed that the snoring children manifested a significant different craniofacial features, such as narrow airway at the level of the soft palate and oropharynx (p < 0.05), more inferiorly positioned hyoid bone (p < 0.05), longer vertical airway length from posterior nasal spine to the base of epiglottis (p < 0.05), more protruding maxilla, and anterior-posterior discrepancy of maxilla and mandible (p < 0.05). In conclusion, our snorer children exhibit significant craniofacial differences compared to non-snorer groups.
Study site: ACC at Hospital Kuala Terengganu, MalaysiaThe ACC is a daycare center consisting of
various specialty clinics such as Pediatrics, Orthopedics,
Otorhinolaryngology, Dental, Oral-maxillofacial, General
Surgery, General Medical, Ophthalmology, Psychiatry, and
Obstetrics and Gynecology clinics.
To determine treatment outcomes in Malaysian children with primary nocturnal enuresis using both non-pharmacological methods and oral desmopressin. Data was collected prospectively from children aged 6-18 years who were referred to the Hospital UKM Enuresis Clinic. Treatment was given to those with a baseline wetting frequency of at least six wet nights/14 nights. Three modalities were offered: fluid management, reward system and oral desmopressin. Response was recorded as partial (> or = 50% reduction in WN from baseline) or full (completely dry). Seventy-one healthy children completed 12 weeks of therapy. Twenty-three children (32.4%) responded to non-pharmacological methods alone (4 full and 19 partial). Another 37 children (51.2%) responded to oral desmopressin (32 to 0.2mg, 4 to 0.4mg and 1 to 0.6mg). Thirty-two percent became dry whilst on therapy. The mean wetting frequency during treatment was significantly reduced (p < 0.01) compared to the baseline mean for both the non-pharmacological group and the desmopressin group. Discontinuation of desmopressin after 12 weeks increased the wetting frequency but this was still significantly lower than at baseline (p < 0.01). No adverse ents were recorded. Treatment of primary nocturnal enuresis in Malaysian children is both effective and well tolerated using fluid management strategies, reward systems and oral desmopressin.
Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy, and peripheral neuropathy).
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Microalbuminuria is the earliest indicator of diabetic kidney disease and generalised vascular endothelial dysfunction. The Microalbuminuria Prevalence (MAP) Study was carried out to assess the prevalence of macroalbuminuria, microalbuminuria and normoalbuminuria in Asian hypertensive patients with type 2 diabetes on usual care. This paper presents a subanalysis of data from patients in Malaysia. In 733 analysed patients, the prevalence of macroalbuminuria and microalbuminuria was 15.7% and 39.7%, respectively. The high prevalence of diabetic nephropathy in these high-risk patients is a cause for concern, and the Malaysian Health Care system should be prepared for a pandemic of end-stage renal disease due to diabetic nephropathy.
Study site: six medical centres in Kuala Lumpur, Kota Bharu,
Kuching and Kota Kinabalu
Missed appointments affect patients' health in addition to reducing practice efficiency. This study explored the rate and reasons of non-attendance among patients with chronic illnesses. It was a cross-sectional descriptive study carried out in a family practice clinic over a one-month period in 2004. Those who failed turn up for scheduled appointments were interviewed by telephone based on a structured questionnaire. Out of 671 patients, the non-attendance rate was 16.7%. Sixty-seven percent of non-attenders were successfully interviewed. Males (p = 0.01), Indians (p = 0.015), patients with coronary artery disease (p = 0.017), multiple diseases (> 4) (p = 0.036) and shorter appointment intervals (p = 0.001) were more likely to default. The main reasons for non-attendance were: forgot the appointment dates (32.9%), not feeling well (12.3%), administrative errors (19.1%) and work or family commitments (8.2%). The majority would prefer a reminder through telephone (71.4%), followed by letters (41.3%). In conclusion, appropriate intervention could be taken based on the reasons identified in this study.
Study site: Family Practice Clinic of the
Department of Primary Care
Medicine, University of Malaya
Medical Centre, Malaysia
The purpose of this study was to detect the frequency of iron deficiency anemia in women attending their first antenatal clinic at a Maternal and Child Health Clinic in Kubang Kerian, a district of Kelantan that is located on the East coast of Malaysia. A cross-sectional study was done over a two-month period and fifty-two Malay women were enrolled in this study. Red blood cell indices and serum ferritin were used as a screening tool for anemia and iron status. Eighteen patients (34.6%) were anemic. The majority were classified as having mild anemia (90%). Four of them had hypochromic microcytic anemia. Of 52 women, 7 had iron deficient erythropoiesis and 11 (61.1%) had iron deficient anemia. The prevalence of iron deficiency anemia in pregnant women was 21.2%, which is similar to other developing countries. The serum ferritin level was significantly associated with the hemoglobin level (p=0.003). Other red blood cell indices were not useful in predicting iron deficient erythropoiesis. It is important to detect iron deficient erythropoiesis during the first antenatal check-up, as it is an early manifestation of iron deficiency anemia. In conclusion, screening for iron deficient is recommended during first antenatal visit because iron deficiency anemia is still the leading cause of nutritional deficiency in pregnant women. This will initiate an early therapeutic intervention so as to reduce public health problem.
Study site: Hopital Universiti Sains Malaysia (HUSM) and the Maternal and Child Health Clinic, Kubang Kerian, Kelantan, Malaysia
In many developed countries, the incidence of rubella and congenital rubella syndrome (CRS) is considered to be negligible due to the availability of an effective vaccine. However, in Malaysia, several CRS cases are seen every year. This casts doubt on the effectiveness of the rubella vaccination programme. Very few seroprevalence studies were done over the years, making it difficult to discuss the effectiveness of the vaccination programme. The objective of this study is to determine the prevalence of rubella immunity among pregnant women attending antenatal clinics in a local teaching hospital. The hospital database on rubella immunity was assessed retrospectively from August 2001 to June 2002. A cross-sectional study of interviewed method as well as determination of rubella immunity by laboratory tests were carried out in July 2002. A total of 414 women were included, of whom 134 women were interviewed. The rubella immunity status was 92.3%. Based on this figure, rubella vaccination programme in Malaysia is a success despite the presence of CRS cases. Malaysia must ensure rubella vaccine coverage among target groups is high in order to minimise CRS cases.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
A prospective clinical study of 181 patients with psoriasis seen in Seremban General Hospital showed the incidence of psoriasis among dermatology outpatients was 2.15%. A significantly higher proportion of male patients were affected, with a male to female ratio of 1.7:1. Within the racial groups; 63 were Malays, 37 Chinese, and 81 Indians. There was a significantly higher proportion of Indians affected as compared with the races. The mean age of patients in this study was 43.7 years old but the mean age of onset of psoriasis in these patients was 33.1 years old. Thirty-one (17.1%) patients gave a positive family history of psoriasis and the mean age of onset of psoriasis was lower (29.3 years old) for patients with a positive family history. Plaque psoriasis was the commonest type of clinical presentation with the scalp being the commonest site affected. Psoriatic arthropathy was seen in 35 (19.3%) patients. Ninety-five (52.5%) patients gave a positive history of factors exacerbating their pre-existing disease and stress was singled out as the most common exacerbating factor.
Study site: Skin clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Studies have shown that smokers rationalize smoking by self-exempting beliefs. This study explored lay beliefs about smoking in Kelantan, Malaysia, using focus groups among outpatients, medical students and staff, and a questionnaire survey of 193 male smokers. In focus groups, patients said they could do something to make smoking safe. When asked, 'Do you think there are any safe ways to smoke?' 132/193 (68%) male smokers described at least one way. The commonest were 'drink water' (69/193, 36%), 'use a filter' (60/193, 31%), 'smoke after food' (27/193, 14%), and 'take sour fruit' (21/193, 11%). At three- or six-month follow-up, numbers agreeing with these beliefs were: for 'drink water' 67/115 (58%), for 'take sour fruit' 61/115 (53%), and for 'smoke after food' 38/115 (33%), with 88/115 (77%) supporting at least one. The main explanations for water were that it cleaned or moistened the lungs or throat. Sour fruit was described as cleaning, and sometimes as 'sharp', able to scrape out the essence of cigarettes. The conclusion is that self-exempting false beliefs about smoking are widespread, and here they probably represent an extension of the traditional humoral system. Anti-smoking campaigns and health workers in smoking cessation services should address these beliefs.
Study site: outpatients clinic (Klinik Perubatan Masyarakat, KPM), Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The study was conducted to determine whether the clinical targets for the control of diabetes recommended by American Diabetes Association can be met in the context of routine diabetes practice. This cross-sectional study was undertaken on 211 type 2 diabetic patients at the Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM) Kubang Kerian, Kelantan between the year 2001-2002. Patients' physical examination and their medical history as well as their family history were obtained by administering a structured questionnaire. Samples of patients' venous blood during fasting were taken and analysed for plasma glucose, glycated haemoglobin and lipid profile. Analysis showed that many patients had comorbidities or complications. A large number of them had poor glycaemic control (73%). Systolic and diastolic blood pressures of 75% and 85% subjects were > or = 130 and > or = 80 mmHg, respectively. Body Mass Index (BMI) values of 66% of the patients were outside the clinical target (BMI > or = 25 in male and > or = 24 kg/m2 in female). The lipid profile showed that 96% of the patients had at least one lipid value outside the clinical target level. In this study, 70% of the patients had total cholesterol > or = 5.2 mmol/L, 87% had LDL cholesterol > or = 2.6 mmol/L, 57% had HDL cholesterol less than the normal range, < or = 1.15 mmol/L in men and < or = 1.4 mmol/L in women, while 46% had triglycerides > or = 1.71 mmol/L. Complications of diabetes were observed in 48% of the total number of patients. As for the patients' systolic blood pressure, age and duration of diabetes were found to have significant effects. Older subjects with a longer duration of diabetes were more hypertensive. Variables that had significant effects on BMI were age, duration of diabetes, glycaemic control and gender. Younger females and newly diagnosed subjects with better glycaemic control (A1C < 7%) were found to have higher BMI values. The overall clinical targets were suboptimal. The prevalence of hyperlipidaemia and hypertension was high. It is imperative that better treatment strategies and methods be adopted to enhance diabetes control and reduce long-term complications of the disease.
Study site: Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM)
BACKGROUND: Secondary prevention pharmacotherapy improves outcomes after acute coronary syndrome (ACS). However, poor medication adherence is common, and various factors play a role in adherence.
OBJECTIVES: The purpose of this study was to evaluate patients' level of adherence to evidence-based therapies at an average of 6 months after discharge for acs and to identify factors associated with self-reported non-adherence.
SETTING: This prospective study was conducted in the outpatient cardiac clinics of Hospital Pulau Pinang, located in Penang Island, a northern state in Malaysia.
METHOD: A random sample of ACS patients (n = 190) who had been discharged on a regimen of secondary preventive medications were included in this study. Six months after discharge and during their scheduled follow-up appointments to cardiac clinics, patients were interviewed using the translated eight-item Morisky Medication Adherence Scale.
MAIN OUTCOME MEASURE: self-reported patients' adherence to medication.
RESULTS: Six months following their hospital discharge, only 35 patients (18.4 %) reported high adherence. Medium adherence was reported in majority of patients (51.1 %). Low adherence was reported in 58 patients (30.5 %). Forgetfulness was the most frequently reported reason for patients' non-adherence to their medications (23.2 %). Furthermore, this study identified 5 factors-namely age, employment status, ACS subtypes, number of comorbidities, and number of prescription medications per day-that may influence Patients' level of adherence to the prescribed regimens.
CONCLUSIONS: Our findings revealed a problem of non-adherence to secondary prevention medications among patients with ACS in Malaysia. Furthermore, this study demonstrates that older patients, unemployed patients, patients with more comorbid conditions, and those receiving multiple medications are less likely to adhere to their prescribed medications 6 months after hospital discharge.
Study site: outpatient cardiac clinics of Hospital Pulau Pinang
BACKGROUND: Familial hypercholesterolemia and familial defective apo lipoprotein B are genetic disorders caused by defects in the low-density lipoprotein receptor gene and apo lipoprotein B 100 genes, respectively. The clinical phenotype of both diseases is characterized by increased plasma levels of total cholesterol and low density lipoprotein cholesterol, tendinous xanthomata, and premature coronary heart disease.
OBJECTIVES: The aim of this study is to perform an association study between different gene sequence variants in low-density lipoprotein and apo lipoprotein B 100 genes to the clinical finding and lipid profile parameters of the study subjects.
MATERIAL AND METHODS: A group of 164 familial hypercholesterolemic patients were recruited. The promoter region, exon 2-15 of the low density lipoprotein gene and parts of exon 26 and 29 of apo lipoprotein B 100 gene were screened by Denaturating Gradient High Performance Liquid Chromatography.
RESULTS: For the apo lipoprotein B 100 gene, those with apo lipoprotein B 100 gene mutation have a significantly higher frequency of cardiovascular disease (P = 0.045), higher low density lipoprotein cholesterol and total cholesterol: high density lipoprotein cholesterol ratio than those without mutation (P = 0.03 and 0.02, respectively). For the low density lipoprotein gene defect those with frame shift mutation group showed the worst clinical presentation in terms of low density lipoprotein cholesterol level and cardiovascular frequency.
CONCLUSIONS: There was a statistically significant association between mutations of low density lipoprotein gene and apo lipoprotein B 100 genes and history of cardiovascular disease, younger age of presentation, family history of hyperlipidemia, tendon xanthoma and low density lipoprotein cholesterol level.
Study site: Cardiology Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
BACKGROUND:Psoriasis is an immune-mediated, chronic, inflammatory skin disease which affects approximately 2% of the world's population. It has a major impact on the patient's quality of life (QoL), influencing career, social activities, family relationships, and all other aspects of life. Many studies have described the various ways in which psoriasis can affect a patient's life. Very little is known, however, about the impact of psoriasis on the QoL of patients treated in Malaysia and the cost of illness in this region.
OBJECTIVES: This study aims to describe the extent to which psoriasis affects the QoL of patients treated in government-run dermatology clinics in Malaysia and to estimate the cost of illness.
METHODS: A total of 250 psoriasis patients treated at eight dermatology clinics in government-run hospitals in Malaysia were studied. The severity of psoriasis was assessed by dermatologists. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI) and Version 2 of the 12-Item Short-Form Health Survey (SF-12v2). Scores on the SF-12v2 of healthy subjects and of patients with other medical conditions, such as depression, diabetes mellitus, hypertension, and ischemic heart disease, were also assessed for comparison. The costs of dermatology outpatient consultant fees, medications, investigations, procedures, transportation, over-the-counter medications, and hospitalization were retrospectively estimated using questionnaires.
RESULTS: The cohort studied had a median Psoriasis Area Severity Index (PASI) score of 9.9 and a median DLQI score of 10.0. The average SF-12v2 scores were 43.68 (standard deviation [SD] 9.23) and 42.25 (SD 10.7) on the Physical Health Summary and Mental Health Summary, respectively. The impact of disease on QoL was found to be greater in those with more extensive psoriatic lesion involvement, in younger patients, and in those with psoriatic arthropathy. Psoriasis was found to affect QoL in both genders equally. Body mass index had no effect on the severity of psoriasis or QoL. Patients with psoriasis had a significantly lower SF-12v2 score than healthy subjects. Comparisons with data for patients with other chronic medical conditions demonstrated that psoriasis has a negative effect on health-related QoL similar to the impact of other chronic conditions. The estimated cost of illness for psoriasis in the current cohort was ringgit Malaysia (RM) 1307.47 per person per year excluding costs of hospitalization. Patients were noted to spend a large amount of money on over-the-counter products obtained without doctors' prescriptions.
CONCLUSIONS: The QoL of patients with psoriasis was significantly impaired compared with that of healthy subjects and was comparable with that of patients with other chronic medical illnesses. The estimated cost of illness of psoriasis in the current study was lower than in other countries, mainly because healthcare costs in public hospitals are heavily subsidized by government and because usage of newer but more expensive treatment options is low in Malaysia.
OBJECTIVE: This study aims to determine the relationships between behavioural and psychological symptoms of dementia (BPSD), cognitive impairment and burden of care of patients with dementia.
METHOD: A cross-sectional, non-randomised study of 65 elderly patients with dementia and their caregivers was conducted over a 3-month period in January 2007 at the memory clinics of Universiti Kebangsaan Malaysia Medical Centre and Hospital Kuala Lumpur. Patients' cognitive functions were assessed with the Mini Mental State Examination (MMSE). Caregivers were interviewed to determine the severity of BPSD and caregiver burden (CB) using the Neuropsychiatric Inventory (NPI) Questionnaire and Zarit Burden Interview (BI) respectively.
RESULTS: Cognitive impairment did not contribute significantly to CB. Multiple linear regression analysis showed that high BPSD scores contributed 0.27 more in BI score, female patients contributed 0.37 less in BI score and caregivers with higher educational level contribute 0.5 more in BI score.
CONCLUSION: Patients' BPSD and male gender, but not cognitive impairment, were associated with CB. Even though CB was experienced more among caregivers with better education, all caregivers should be screened to ensure their general well-being.
KEYWORDS: BPSD; Caregiver burden; Cognitive impairment
Study site: Memory clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Allergic rhinitis is the single most common chronic allergic disease affecting an estimated four million people in Malaysia. House dust mites, grass pollens and fungal spores play has been identified to play a major role in the pathogenesis of allergic rhinitis. However, sensitization to pollen and spores in Malaysia is not well documented. On the basis of the results of an aerobiological survey of the common mold spores and pollens in the Klang Valley, twelve local extracts of molds and two local extracts of grass pollens were prepared by the Institute for Medical Research for this study. The study evaluated the prevalence of skin prick test (SPT) reactivity to the extracts of those airborne molds and pollens in allergic rhinitis patients in the Klang Valley. A total of 85 allergic rhinitis patients were recruited. All molds and grass pollens extracts tested, elicited positive response to SPT. Among the molds extracts, Fusarium was observed to have the highest prevalence of SPT reactivity (23.5%), followed by Aspergillus flavum (21.2%), Dreselera orysae (18.8%), Alternaria sp (17.6%), Curvularis eragrostidis (17.6%), Penicillium oxa (16.5%), Pestolotriopsis gtuepini (16.5%), Rhizopphus arrhi (16.5%), Aspergilluls nigus (15.3%). Penicillium choy (12.9%), Aspergillus fumigatus (11.8%), and Cladosporium sp (4.7%). In the grass pollen, the SPT reactivity to Ischaemum and Enilia is 14.1% and 5.9% respectively. However, the prevalence of SPT reactivity was not influenced by the age, sex, ethnicity, symptomatology and concurrent allergic condition. We have documented the prevalence of skin prick test reactivity to common molds and grass pollens in the Klang valley, which is comparable to the neighboring countries. Its prevalence in our allergic rhinitis patients suggests that it has a role in pathogenesis of allergic diseases. A larger representative sample involving multi-centric centers in Malaysia should be encouraged in the near future.
Study site: ENT
Department, Pusat Perubatan University Kebangsaan Malaysia
(PPUKM)
In terminally-ill patients, effective measurement of health-related quality of life (HRQoL) needs to be done while imposing minimal burden. In an attempt to ensure that routine HRQoL assessment is simple but capable of eliciting adequate information, the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF: 8 items) was developed from its original version, the McGill Quality of Life Questionnaire (MQOL: 17 items). Psychometric properties of the MQOL-CSF were then tested in palliative care patients consisting of 55 out-patients, 48 hospice patients and 86 in-patients: The MQOL-CSF had little respondent burden (mean completion time = 3.3 min) and was evaluated as 'very clear' or 'clear' (98.2%), comprehensive (74.5%) and acceptable (96.4%). The internal consistency reliability was moderate to high (Cronbach's alpha = 0.462-0.858) and test-retest reliability (Spearman's r(s)) ranged from 0.512-0.861. Correlation was moderate to strong (0.478-0.725) between items in the short form and their analogous domains in the MQOL. Most MQOL-CSF items showed strong associations with their own domain (r(s) > or = 0.40). Scores from MQOL-CSF significantly differentiated between patients with differing haemoglobin levels (p < 0.05). Construct validity was overall supported by principal component analysis. It is concluded that the MQOL-CSF is a feasible tool with favourable psychometric properties for routine HRQoL assessment in the palliative care population.
Study site: out-patient palliative care clinic; a hospice centre and hospital inpatient wards, United Kingdom