Displaying publications 41 - 60 of 288 in total

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  1. Liew SK, Shim BJ, Gong HS
    Korean J Neurotrauma, 2020 Oct;16(2):126-137.
    PMID: 33163420 DOI: 10.13004/kjnt.2020.16.e48
    Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.
    Matched MeSH terms: Referral and Consultation
  2. Hussein N, Malik TFA, Salim H, Samad A, Qureshi N, Ng CJ
    J Community Genet, 2020 Oct;11(4):413-420.
    PMID: 32666196 DOI: 10.1007/s12687-020-00476-2
    Family history has long been recognised as a non-invasive and inexpensive tool to identify individuals at risk of genetic conditions. Even in the era of evolving genetic and genomic technology, the role of family history in predicting individual risk for genetic testing and guiding in preventive interventions is still relevant, especially in low-resource countries. The aim of this study was to explore primary care doctors' views and experiences in family history taking and how they utilised family history in day-to-day clinical consultations in Malaysia. Four focus group discussions and six in-depth interviews involving 25 primary care doctors were conducted. Three themes emerged from the analysis: (1) primary care doctors considered family history as an important part of clinical assessment, (2) proactive versus reactive approach in collecting family history and (3) family history collection was variable and challenging. Family history was documented in either free text or pedigree depending on the perception of its appropriateness during the consultation. This study highlighted the need to improve the approach, documentation and the implementation of family history in the Malaysian primary care settings. Integrating family filing concept with built-in clinical decision support into electronic medical records is a potential solution in ensuring effective family history taking in primary care.
    Matched MeSH terms: Referral and Consultation
  3. Flaherty GT, Leong SW, Finn Y, Sulaiman LH, Noone C
    J Travel Med, 2020 Sep 26;27(6).
    PMID: 32634210 DOI: 10.1093/jtm/taaa110
    BACKGROUND: Little is known about the awareness of travellers with diabetes about the health effects of international travel. This study aimed to design and validate a questionnaire to examine the travel health knowledge, attitudes and practices of people living with type 1 diabetes.

    METHODS: A set of 74 items based on a conceptual framework analysis underwent revision and its content validity was established. Items were grouped into three domains. A development study was conducted to establish evidence regarding their factorial structure. A construct validation study was then conducted in which the retained items were tested in an independent sample using confirmatory factor analysis (CFA).

    RESULTS: Four factors emerged from our development study and were labelled as pre-travel preparation-insect bites, pre-travel preparation-consultation, insulin and glycaemic control and travel risk behaviour. A CFA confirmed the factorial structure identified in the development study in an independent sample. Each factor loading had a significant (P 

    Matched MeSH terms: Referral and Consultation
  4. Khana R, Mahinderjit Singh M, Damanhoori F, Mustaffa N
    JMIR Med Inform, 2020 Sep 23;8(9):e21584.
    PMID: 32965225 DOI: 10.2196/21584
    BACKGROUND: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient's personal medical data excessively with colleagues or the public. Such an act would reduce the physician's trustworthiness from the patient's perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening.

    OBJECTIVE: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians.

    METHODS: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum.

    RESULTS: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P

    Matched MeSH terms: Referral and Consultation
  5. Mai CW, Tan JSH, Koay GWL, Lim LYX
    Pharmacy (Basel), 2020 Sep 13;8(3).
    PMID: 32933158 DOI: 10.3390/pharmacy8030170
    Dietary supplementation is increasingly sought after by consumers looking to meet the demands of a modern lifestyle. Effective supplementation requires knowledge of the purpose and proper use of nutritional supplements. Unverified or inadequate guidance on supplementation can propagate misconceptions and increase undue fears of side effects. Community pharmacists are best placed to guide consumers on nutritional supplement use. In this review, a panel comprised of community pharmacists, pharmacy academia, and dietitians (n = 6) convened to provide an experience- and evidence-based guidance on rational drug use, patient education, and integrated and personalized nutrition care in both community and hospital pharmacy settings. A novel framework to guide community pharmacist-led consultations on supplementation is proposed. The four-step CARE (Categorize, Assess, Recommend, Empower) guide was developed to facilitate and optimize outcomes of pharmacist-led nutritional supplement consultation. Telehealth advancements in the form of digital health applications and personalized nutrigenomic DNA testing support Integrative Nutrition Care, and will further promote appropriate supplementation use to improve overall well-being in the community. Practical implementation of the CARE guide is necessary to ascertain its applicability for optimizing outcomes of pharmacist-led consultation and the recommendation of nutritional supplements.
    Matched MeSH terms: Referral and Consultation
  6. Jamal AA, Aldawsari ST, Almufawez KA, Barri RM, Zakaria N, Tharkar S
    Int J Med Inform, 2020 09;141:104202.
    PMID: 32506051 DOI: 10.1016/j.ijmedinf.2020.104202
    BACKGROUND: The use of social media is widespread globally. It provides a quicker and faster means of efficient exchange of communications. The use of Twitter Applications to seek mental health advice is becoming popular.

    OBJECTIVES: This study aims to identify the determinants associated with Twitter use in psychiatric consultations and to assess the level of satisfaction in using the microblogging platform. In addition, the level of e-health literacy is also assessed among users.

    METHODS: The target population included Twitter users seeking psychiatric consultation. A leading psychiatrist's twitter account with 4.5 million followers was selected and consent obtained. A validated Patient Satisfaction Questionnaire was adopted to assess the level of satisfaction in Twitter use and e-health literacy. The questionnaire was tagged to the chosen Twitter account and reminders were sent until the sample size was reached. Data was analysed using SPSS version 22.0. The analysis included descriptive statistics tabulation, multi-response analysis, and cross-tabulation for satisfaction variables and the chi-square test was used to measure association between different variables.

    RESULTS: The study obtained 155 completed response sheets, of which 52 were Twitter users seeking psychiatric advice while the rest sought general health advice. Most of the study participants were females (71.6 %). Women, single status and income range between 4000-9000 Saudi riyal were found to be significantly associated with Twitter use for psychiatric consultation. Generally, most of the participants were satisfied with Twitter in seeking psychiatric consultation that reduced financial disbursement. Furthermore, concerns were expressed regarding the waiting period, word limitations and issues of privacy. The e-health literacy was higher among the participants.

    CONCLUSION: Psychiatric consultations via Twitter is more popular among women. By addressing privacy issues and reducing response time, Twitter may be used as a major platform to deliver mental health services to the population.

    Matched MeSH terms: Referral and Consultation
  7. Ong LK, Sivaneswaran L, Mohd Najib A, Devindran M, Say BL, Rohan MJ
    Med J Malaysia, 2020 07;75(4):400-402.
    PMID: 32724002
    In Malaysia, COVID-19 pandemic recorded considerable number of cases. Many hospitals have been converted into COVID-19 centres to manage these cases. The Penang General Hospital was designated as a hybrid hospital to manage both COVID-19 and non-COVID-19 cases. Consequently, services across specialties, including urology have been affected. Triage of referrals was necessary to ensure optimum patient care, thus we designed a triage system to address this situation. A record screening system of patients was also implemented to limit outpatient appointments. We share this early experience in managing urology patients during this pandemic.
    Matched MeSH terms: Referral and Consultation*
  8. Sufiza Ahmad N, Makmor-Bakry M, Hatah E
    Saudi Pharm J, 2020 Jul;28(7):850-858.
    PMID: 32647487 DOI: 10.1016/j.jsps.2020.06.003
    Introduction: Medicine price transparency initiatives provide public or government on information about the product's prices and the components that may influence the prices, such as volume and product quality. In Malaysia, medicine price transparency has become part of the government's strategies in ensuring adequate, continuous and equitable access to quality, safe, effective and affordable medicines. Since the effect of medicine price transparency depend critically on how prices are presented, this study aims to evaluate the stakeholders' perspective of medicine price transparency practice in the private healthcare system in Malaysia.

    Methods: This study was conducted as face-to-face, semi-structured interview. Respondents from private pharmaceutical industries, community pharmacists, general practitioners, private hospital pharmacists, governments, academicians and senior pharmacist were recruited using purposive sampling. Using phenomenological study approach, interviews were conducted, and audio recorded with their consent. Data were transcribed verbatim and analysed using thematic analysis with Atlas.ti 8 software and categorised as strengths, weaknesses, opportunities and threats (SWOT).

    Results: A total of 28 respondents were interviewed. There was a mixed perception regarding the price transparency implementation in Malaysia's private healthcare settings. The potential strengths include it will provide price standardization, reduce price manipulation and competition, hence allowing the industry players to focus more on patient-care services. Moreover, the private stakeholders were concerned that the practice may affect stakeholders' business and marketing strategy, reduce profit margin, increase general practitioner's consultation fees and causing impact on geographical discrepancies. The practice was viewed as an opportunity to disseminate the truth price information to consumer and strengthen collaboration between healthcare industries and Ministry of Health although this may become a threat that affect the business survival.

    Conclusion: Price transparency initiatives would benefit the pharmaceutical industries, consumer and countries, but it needs to be implemented appropriately to prevent price manipulation, market monopoly, and business closure. Future study may want to evaluate the impact of the initiatives on the business in the industry.

    Matched MeSH terms: Referral and Consultation
  9. Isa NMM, Aziz AFA
    Korean J Fam Med, 2020 Jul;41(4):256-262.
    PMID: 32019295 DOI: 10.4082/kjfm.19.0012
    BACKGROUND: Lower urinary tract symptoms (LUTS) are common among elderly men. However, seeking help for this problem is mostly delayed until complications arise. Primary care clinics serve as the first point of contact for a person's health needs throughout their life. This study aimed to determine the prevalence of LUTS among primary care attendees, and the factors that influence seeking medical intervention at primary care clinics.

    METHODS: Using a universal sampling technique, 460 male patients aged 60 and above visiting an urban based public primary care clinic were recruited. An interviewer administered the questionnaire which used International Prostate Symptoms Score and International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms-Quality of Life.

    RESULTS: The prevalence of any LUTS and clinically significant LUTS were 89.8% and 20.5%, respectively. Among the 385 participants who completed the study, only 41.8% had consulted a doctor for LUTS. Among those with moderate/severe symptoms only 57.6% had sought medical intervention. Multiple logistic regression analysis showed that the presence of more than two comorbidities (P=0.004; odds ratio [OR], 4.695; 95% confidence interval [CI], 1.632-13.508) and quality of life (P=0.002; OR, 1.271; 95% CI, 1.091-1.481) were independent factors significantly associated with seeking help.

    CONCLUSION: Prevalence of LUTS among elderly men undergoing primary care is high, but more than half of the patients had not sought medical attention. Increasing comorbidities and impact on quality of life influenced elderly men with LUTS to seek help.

    Matched MeSH terms: Referral and Consultation
  10. Lee YK, Chor YY, Tan MY, Ngio YC, Chew AW, Tiew HW, et al.
    Patient Educ Couns, 2020 05;103(5):1049-1051.
    PMID: 31866195 DOI: 10.1016/j.pec.2019.12.005
    OBJECTIVE: To measure the level of shared decision-making (SDM) in primary care consultations in Malaysia, a multicultural, middle-income developing country.

    METHODS: A cross-sectional study was conducted in an urban, public primary care clinic. Convenience sampling was used to recruit participants, and audio-recorded consultations were scored for SDM levels by two independent raters using the OPTION tool. Univariate and multivariate analysis was conducted to determine factors significantly associated with SDM levels.

    RESULTS: 199 patients and 31 doctors participated. Mean consultation time was 14.3 min (+ SD 5.75). Patients' age ranged from 18 to 87 years (median age of 57.5 years). 52.8 % of patients were female, with three main ethnicities (Malay, Chinese, Indian). The mean OPTION score was found to be 7.8 (+ SD 3.31) out of 48. After a multivariate analysis, only patient ethnicity (β= -0.142, p 

    Matched MeSH terms: Referral and Consultation/statistics & numerical data*
  11. Mohd Suan MA, Tan WL, Ismail I, Abu Hassan MR
    Asian Pac J Cancer Prev, 2020 May 01;21(5):1253-1258.
    PMID: 32458630 DOI: 10.31557/APJCP.2020.21.5.1253
    BACKGROUND: Patients with positive immunochemical faecal occult blood test results were found to have poor compliance for a subsequent colonoscopy procedure. This study was conducted to explore patients' perceived deterrence for colonoscopy following a positive stool test.

    METHODS: Using qualitative study method, a phone interview was conducted with 16 patients to elicit their views on the reasons for failure to attend the colonoscopy procedure following a positive stool test. The interviews were audio recorded, transcribed verbatim and translated before proceeded with the data analysis. Content analysis was made on the translated interview, followed by systematic classification of data by major themes.

    RESULTS: Reasons for nonattendance were categorized under five main themes; unnecessary test, fear of the procedure, logistic obstacles (subthemes; time constraint, transportation problem), social influences, and having other health priority. Lacking in information about the procedure during the referral process was identified to cause misperception and unnecessary worry towards colonoscopy. Fear of the procedure was commonly cited by female respondents while logistic issues pertaining to time constraint were raised by working respondents.

    CONCLUSIONS: More effective communication between patients and health care providers are warranted to avoid misconception regarding colonoscopy procedure. Support from primary care doctors, customer-friendly appointment system, use of educational aids and better involvement from family members were among the strategies to increase colonoscopy compliance.

    Matched MeSH terms: Referral and Consultation
  12. Kampan NC, Madondo MT, Reynolds J, Hallo J, McNally OM, Jobling TW, et al.
    Sci Rep, 2020 02 10;10(1):2213.
    PMID: 32042020 DOI: 10.1038/s41598-020-59009-z
    Pre-operative discrimination of malignant masses is crucial for accurate diagnosis and prompt referral to a gynae oncology centre for optimal surgical intervention. HGSOC progression is correlated with local and systemic inflammation. We hypothesised that inclusion of inflammatory biomarkers in sera may improve diagnostic tests. In the training cohort, we tested four existing clinical tests (RMI score and ROMA, CA125 and HE4) and a panel of 28 immune soluble biomarkers in sera from 66 patients undergoing surgery for suspected ovarian cancer. Six promising immune biomarkers alone, or in combination with conventional tests, were subsequently analysed in an independent validation cohort (n = 69). IL-6 was identified as the main driver of variability followed closely by conventional diagnostic tests. Median sera IL-6 was higher in HGSOC patients compared to those with a benign mass or controls with normal ovaries (28.3 vs 7.3 vs 1.2 pg/ml, p  3.75 pg/ml as primary triage followed by conventional tests (CA125 or RMI score) identified ovarian cancer in patients with a misclassification rate of 4.54-3.03%, superior to the use of CA125 or RMI alone (9.09 to 10.60). The validation cohort demonstrated a similar improvement in the diagnostic sensitivity following addition of IL-6. IL-6 in combination with conventional tests may be a useful clinical biomarker for triage of patients with a suspected malignant ovarian mass.
    Matched MeSH terms: Referral and Consultation
  13. Gil Cuesta J, van Loenhout JAF, de Lara Banquesio ML, Mustaffa M, Guha-Sapir D
    Disaster Med Public Health Prep, 2020 02;14(1):34-38.
    PMID: 31679549 DOI: 10.1017/dmp.2019.99
    INTRODUCTION AND OBJECTIVES: Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital.

    METHODS: We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014.

    RESULTS: We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period.

    CONCLUSIONS: ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.

    Matched MeSH terms: Referral and Consultation/trends*; Referral and Consultation/statistics & numerical data
  14. Blebil A, Dujaili J, Elkalmi R, Tan HLK, Tai MS, Khan TM
    J Pharm Bioallied Sci, 2020 01 29;12(1):64-71.
    PMID: 32801602 DOI: 10.4103/jpbs.JPBS_152_19
    Introduction: Pharmacists have been well recognized as an active and have a more integrated role in the preventive services within the National Health Services. This study assessed the community pharmacists' attitudes, beliefs, and practices toward oral health in the Malaysian setting.

    Materials and Methods: A cross-sectional survey-based study was used to conduct this project. An anonymous self-administered questionnaire was developed and distributed among community pharmacists within Kuala Lumpur and Selangor states areas, Malaysia. The data collection was carried out from the beginning of November to the end of December 2018.

    Results: Of the 255 pharmacists, 206 agreed to participate in the study, yielding a response rate of 80.8%. Overall, approximately half of the pharmacists provided two to five oral health consultations per week and two to five over the counter (OTC) oral health products recommendations per week. The main services provided by community pharmacists in were the provision of OTC treatments (93.7%), referral of consumers to dental or medical practitioners when appropriate (82.5%), and identify signs and symptoms of oral health problems in patients (77.2%). In addition, more than 80% of the pharmacists viewed positively and supported integrating oral health promotion and preventive measures into their practices. The most commonly reported barriers to extending the roles of pharmacists in oral health care include lack of knowledge or training in this field, lack of training resources, and lack of oral health educational promotion materials.

    Conclusion: The study shows that community pharmacists had been providing a certain level of oral health services and play an important role in oral health. The findings highlighted the need of an interprofessional partnership between the pharmacy professional bodies with Malaysian dental associations to develop, and evaluate evidence-based resources, guidelines, the scope of oral health in pharmacy curricula and services to deliver improved oral health care within Malaysian communities.

    Matched MeSH terms: Referral and Consultation
  15. Mohd Shaiful Ehsan Shalihin, Iskandar Firzada Osman, Muhammad Hapizie Bin Din
    MyJurnal
    Introduction: Long waiting time is a common issue complained by diabetic patients that came for an
    early morning appointment in a health clinic. Therefore, an audit was conducted among diabetic patients in
    a primary care clinic with the aim to assess the patients’ waiting time and to formulate strategies for
    improvement. Methods: This audit was conducted for four weeks using a universal sampling method in
    November 2017. All diabetic patients who attended the clinic during this period were included except those
    who required longer period such as critically ill patients or those who came for repeat medication or
    procedures. The arrival and departure time for each station was captured using the modified waiting time
    slip, which is manually filled at every station. The waiting and consultation time for registration, screening,
    laboratory investigation, diabetic educator, doctor and pharmacy were recorded. The data were entered into
    the statistical software SPSS version 17 for analysis. Results: Results showed that all patients were registered
    within 11.0 minutes (SD=2.52min). Average total waiting time to see a diabetic educator and a doctor was
    20.9 minutes (SD=15.53min) and 33.23 minutes (SD=27.85min), respectively. Average waiting time for other
    stations was less than 10 minutes. Average total time spend in the clinic for a diabetic patient was 107.58
    minutes, which is comparable to a non-diabetic patient. The identified problems were due to the poor
    tracing and filing system. Conclusion: Improvement strategies recommended include enforcing early file
    tracing prior to appointment and providing a checklist for consultation by doctors and diabetic educators.
    Matched MeSH terms: Referral and Consultation
  16. Nurjasmine Aida Jaman, Nor Azam Kamaruzaman, Abdul Hadi Said
    Malaysian Family Physician, 2020;15(2):46-49.
    MyJurnal
    Undernutrition remains a major public health concern, especially in developing countries. Despite
    being rich in resources, Malaysia is still home to children sufering from severe undernutrition.
    Tis paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper
    weaning which was overlooked. Tis case highlights the importance of recognizing the early signs of
    kwashiorkor to allow for early referrals for proper management and prevent its possible complications.
    Matched MeSH terms: Referral and Consultation
  17. Muhamad Imran Abdulah, Ikmal Abdul Hakim, Rosni Amin, Rosliza Parumo, Ma, Bee Chai, Noraziyah Abdul Aziz, et al.
    Q Bulletin, 2020;1(29):16-27.
    MyJurnal
    The Department of Oral & Maxillofacial Surgery at Hospital Sultanah Aminah, Johor Bahru started managing patients who lost their eyeballs with ocular prosthesis in 2013. Unfortunately, there was an increasing trend of failed ocular prosthesis from 2013-2015. The failure rate went from 28.6% in 2013 to 40% in 2014 and increased to 44.4% in 2015. Failed ocular prosthesis not only leads to dissatisfied patients but also an increase in cost due to redoing of prosthesis. The objective of this project was to reduce the incidence rate of failed ocular prosthesis. A failed case is when the prosthesis does not pass the issue stage and has to be redone from the beginning. The standard failure rate is 0%, as the average number of cases per year is only about 10 cases. We determined the contributing factors of failed ocular prosthesis by analysing retrospective data from patients’ dental and lab records. This was followed by a self-administered questionnaire on reasons for failed cases which was distributed among the dentists and lab technicians in our department. The contributing factors that were identified included insufficient knowledge or skill of dentist and lab technicians in the construction of the ocular prosthesis, as well as improper screening of new cases which was the main factor of all the failed cases. The strategies for change included improving the process of care by creating a checklist for proper screening of new patients, mentoring of new staff, and continuous training on construction of ocular prosthesis, Fabricated Iris Mould innovation technique and early referral for insertion of eye conformer. The interventions that were implemented reduced the failure rate to 20% in 2016 followed by 0% in 2017, 2018 and 2019. Ongoing efforts are being done to replicate this project in other Oral & Maxillofacial Surgery clinics in Johor.
    Matched MeSH terms: Referral and Consultation
  18. Putri Yubbu, Johan Aref Jamaluddin, Lydia Chang Mun Yin, Geetha Kandavello, Mazeni Alwi, Hasri Samion, et al.
    MyJurnal
    The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.
    Matched MeSH terms: Referral and Consultation
  19. Keah SH, Ng SC
    Malays Fam Physician, 2020;15(3):10-21.
    PMID: 33329859
    Basal cell carcinoma (BCC) is a common disease of the skin caused principally by prolonged solar radiation exposure. It is normally a malignancy with favorable prognostic features and is potentially curable by standard excision. In White populations with high disease incidence, general practitioners (GPs) play a vital role in diagnosing and managing BCC, including surgical excision. Dedicated care at the primary care level by adequately trained GPs is conceivably cost effective for the health system and more convenient for the patient. In Asia and other parts of the world with low incidence, this valuable role of GPs may appear to be inconsequential. In this regard, any justification for the involvement of local GPs in BCC surgery is debatable. This article aims to provide a clinical update on essential information relevant to BCC surgery and advance understanding of the intricate issues of making a treatment decision at the primary care level.

    Case Report: Madam Tan, a 71-year-old Malaysian Chinese lady, otherwise healthy, presented to her local GP with a complaint of a nodule over the left cheek that had been there for more than a decade. Her concern was that the lesion was growing and had become conspicuous. She had spent most of her life as a farmer working in her orchard.Upon examination, she had an obvious dome-shaped nodule over the left cheek measuring approximately 1.8 cm in diameter. The lesion was firm, pigmented, well-demarcated, and slightly ulcerated at the top. Clinically, she was diagnosed with a pigmented nodular basal cell carcinoma of the left cheek. Examination of the systems was unremarkable.She requested that the consulting GP remove the growth. The cost for specialist treatment and waiting time at the local hospital were her concerns.

    Clinical Questions: Can the basal cell skin cancer be excised safely and effectively in the local primary care setting? What are the crucial preoperative concerns?

    Matched MeSH terms: Referral and Consultation
  20. Siti BC, Zulkifli MM, Mohd Yusoff SS, Muhamad R, Ahmad TM
    Malays Fam Physician, 2020;15(3):90-94.
    PMID: 33329869
    Schizencephaly is a very rare congenital birth defect. It is characterized by a cortical brain malformation that manifests as a grey-matter-lined cleft extending from the ependyma to the pia mater. It is a rare condition, and few cases have been reported in the literature. The exact cause is unknown. Herein, we report a case of an infant presenting with left side hemiparesis. The CT scan of her brain revealed right fronto-temporal and left parieto-temporal open-lip schizencephaly; thus, urgent referral to a pediatric neurologist was made for early intervention.
    Matched MeSH terms: Referral and Consultation
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