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Fulltext Knowledge and perceptions of palliative care among cancer patients in a tertiary hospital

Mohd Arif Atarhim, Nurul Asyiqin Ibrahim, Chong Zhi Yin, Santhna Letchmi Panduragan, Hamidah Hassan

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):26-0.
MyJurnal

Introduction: Early integration in palliative care for patients with advanced cancer has been correlated with an improvement quality of life, relieved depression while having survival benefits. Negative perceptions towards pal- liative care or misconception about the idea of palliative care were reported as one of the causes for late referral by physicians. The aim of this study was to determine the knowledge and perception of palliative care among can- cer patients in a tertiary hospital. Methods: A cross-sectional survey with populations of 139 cancer patients was conducted using convenience sampling. Quantitative data were collected by a structured questionnaire. A total of 92 responses were obtained. Results: Most of the participants were female (66.3%), Malay (71.7%) and attended secondary school (56.5%). The mean age of participants was 56.13 (±12.61) years while the mean income was RM 1944.20 (±2472.70). Majority of the participants had breast cancer (37.0%), followed by colorectal cancer (32.6%). Many of them were in stage IV (42.4%), followed by stage III (25.0%).Most of the cancer patients had a high level of knowledge and positive perception towards palliative care. They agreed that psychological, social and spiritual issues are a part of palliative care which helped to manage pain and other symptoms. Besides, responses portrayed positive perceptions of palliative care through the aspect of emotional reactions, cognitive reactions and palliative care needs. Conclusions: The current study has demonstrated that cancer patients in the tertiary hospital had better knowledge and perceptions in palliative care. High knowledge level and positive perception towards palliative care might increase the acceptance and palliative care practiced.

Matched MeSH terms: Physicians
Are eye-care practitioners fitting scleral contact lenses?

Woods CA, Efron N, Morgan P, International Contact Lens Prescribing Survey Consortium

Clin Exp Optom, 2020 07;103(4):449-453.
PMID: 32519339 DOI: 10.1111/cxo.13105

BACKGROUND: To determine the extent of scleral lens fitting worldwide and to characterise the associated patient demographics.
METHODS: Survey forms were sent to contact lens fitters around the world, every year for 20 consecutive years (2000 to 2019). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey. Data were analysed for those countries reporting ≥ 1,000 contact lens fits during this period.
RESULTS: A total of 369,209 contact lens fits were recorded from 40 eligible countries, comprising 2,309 scleral lens fits and 366,900 other (non-scleral) lens fits. Overall scleral lenses represented 0.76 per cent of all contact lens fits with significant differences between countries (p

Matched MeSH terms: Practice Patterns, Physicians'
Fulltext The Psychological Sequelae during mental health and COVID-19 Pandemic: learning from the past for today’s coping styles

Hatta, S.

Medicine & Health, 2020;15(1):1-4.
MyJurnal

Psychophysiological effect associated to an event is inseparable with regard to the human’s mental health (Celik 2010; Cannon 1987; Roxo et al. 2011; Laird & Lacasse 2014). The manifestation of psychophysiological phenomenon in relation to an event has been observed during pre-modern era and inspired physician like Avicenna from the influence of the great thinker of Aristotle and Plato. Avicenna or IbnuSina, the Persian-born philosopher and physician from the Greco-Islamic era, has made his standpoint on the clinical importance of pulsology (Celik 2010). In his earlier concepts on pulse patterns, it was found that pulse would rise when he or she is anticipating an event, especially if an event is meaningful and related to him or her. Avicenna documented in dealing with such events, the psychophysiological changes that were observed, i.e. increased pulse from normal pulse. For example, a man who is approaching a house with a lady that he loved, started to experience tachycardia and palpitation. Sphygmology, a study of pulses is based on the contribution by Ibnu-Sina (Zarshenas et al. 2013). It is a relatively simple, practical and inexpensive means, having a significant diagnosis yield (Zarshenas et al. 2013). It has been recognised through the history of medicine, over the centuries, that we have a better understanding on the fundamental concept of coping with stress by observing our own pulses. Using this modest physiological approach, it has contributed to the modern way in dealing with distressed situation-the psychophysiology of biofeedback therapy and instilling the Buddhist teaching of mindfulness. For example in the former, biofeedback is a simple way of overcoming stress. Biofeedback therapy is a method that trains people to enhance their health by regulating certain bodily processes that normally happen involuntarily (Abgrall-Barbry & Consoli 2006). Once we are in a stressful state, our pulse and blood pressure will increase. Meditating, or self-dialogueand telling our brain that, “I am in control and can dictate my pulse from the highest to lowest possible beat,” can be helpful in dealing with our stress level via higher mental function coordination. Indeed, regulation of basic physiological phenomena and psychological input-“calming the mind” has both anatomical and neurophysiological explanation via the reticular activating system and thalamic integration. Understanding a simple way in managing with stress, especially during the difficult and stressful time can be gratifying and rewarding. This is especially true when it comes to inconveniences, hassle and problems due to coronavirus disease 2019 (COVID-19) pandemic, and during the movement control order (MCO).

Matched MeSH terms: Physicians
Fulltext Readiness for interprofessional education among preclinical and clinical year medical students - does it change over the years?

Kavitha Ashok Kumar, Ashok Kumar Jeppu

Malaysian Journal of Medicine and Health Sciences, 2020;16(107):63-66.
MyJurnal

Introduction: Health care involves team work. Physicians, nurses, pharmacists and social workers need to work in collaboration to deliver quality health care. It is therefore vital that team work and collaboration are integrated into the training of medical students. In a medical school where interprofessional education has not been introduced, the preclinical students are trained in silos whereas the clinical students have interprofessional experiences in hospital and community centers. This study was conducted to explore medical student’s receptiveness for interprofessional education and to identify any differences in attitude among the preclinical and clinical year students. Methods: This study adopted a cross-sectional study design using purposive sampling technique at a private medical school in Malaysia. Participants completedthe standardized Readiness for inter-professional learning Scale and the data was analyzed. Results: 436 students witha mean age of 22 years participated in this study. Among them, 170 were from preclinical and 266 were from clinical years Both the groups scored high on team work while clinical students scored better than preclinical students in understanding professional identity and recognizing their roles. Conclusion: This study shows a readiness among medical students for IPE. Clinical year medical student’s attitude was similar to preclinical students.

Matched MeSH terms: Physicians
Fulltext Understanding Practice Patterns of COPD: A Survey of Physicians in Nepal, Sri Lanka and Malaysia

Chokhani R, Muttalif AR, Gunasekera K, Mukhopadhyay A, Gaur V, Gogtay J

Pulm Ther, 2021 Jun;7(1):251-265.
PMID: 33855650 DOI: 10.1007/s41030-021-00153-w

INTRODUCTION: There is much recent data from Nepal, Sri Lanka and Malaysia that can help us understand the practice patterns of physicians regarding the diagnosis and management of chronic obstructive pulmonary disease (COPD) in these countries. We conducted this survey to understand the practice patterns of physicians related to the diagnosis and management of COPD in these three countries.
METHODS: This questionnaire-based, observational, multicentre, cross-sectional survey was carried out with 438 randomly selected physicians consulting COPD patients.
RESULTS: In the survey, 73.29% of the physicians consulted at least five COPD patients daily (all patients > 40 years of age). 31.14% of the COPD patients visiting their doctors were women. Among physicians, 95.12% reported that at least 70% of their patients were smokers. 34.18% of the physicians did not routinely use spirometry to diagnose COPD. Most physicians preferred a short-acting β2-agonist (SABA) (28.19%) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group-A and long-acting muscarinic receptor antagonist plus long-acting β2-agonist/inhaled corticosteroids (LAMA + LABA/ICS) in both the GOLD Group-C (39.86%) and Group-D (72.89%) patients. A significant number (40.67%) of physicians preferred LABA/LAMA for their GOLD Group-B patients. A pressurised metered dose inhaler (pMDI) with or without spacer was the most preferred device. Only 23.67% of the physicians believed that at least 70% of their patients had good adherence (> 80%) to therapy. Up to 54.42% of the physicians prescribed inhalation therapy to every COPD patient. Also, 39.95% of the physicians evaluated their patients' inhalation technique on every visit. Up to 52.67% of the physicians advised home nebulisation to > 10% of patients, with nebulised SABA/short-acting muscarinic receptor antagonist (SAMA) being the most preferred management choice. Most physicians offered smoking cessation advice (94.16%) and/or vaccinations (74.30%) as non-pharmacological management, whereas pulmonary rehabilitation was offered by a smaller number of physicians. Cost of therapy and poor technique were the most common reasons for non-adherence to COPD management therapy.
CONCLUSION: Awareness of spirometry can be increased to improve the diagnosis of COPD. Though physicians are following the GOLD strategy recommendations for the pharmacological and non-pharmacological management of COPD, awareness of spirometry could be increased to improve proper diagnosis. Regular device demonstration during each visit can improve the inhalation technique and can possibly increase adherence to treatment.

Matched MeSH terms: Physicians
Fulltext Dengue Fever: Therapeutic Potential of Carica papaya L. Leaves

Sarker MMR, Khan F, Mohamed IN

Front Pharmacol, 2021;12:610912.
PMID: 33981215 DOI: 10.3389/fphar.2021.610912

Dengue, a very widespread mosquito-borne infectious disease caused by Aedes aegypti virus, has been occurring during the monsoons every year. The prevalence and incidence of dengue fever and death due to its complications have been increased drastically in these recent years in Bangladesh, Philippines, Thailand, Brazil, and India. Recently, dengue had spread in an epidemic form in Bangladesh, Thailand, and Philippines. Although the infection affected a large number of people around the world, there is no established specific and effective treatment by synthetic medicines. In this subcontinent, Malaysia could effectively control its incidences and death of patients using alternative medication treatment mainly prepared from Carica papaya L. leaves along with proper care and hospitalization. Papaya leaves, their juice or extract, as well as their different forms of preparation have long been used traditionally for treating dengue fever and its complications to save patients' lives. Although it is recommended by traditional healers, and the general public use Papaya leaves juice or their other preparations in dengue fever, this treatment option is strictly denied by the physicians offering treatment in hospitals in Bangladesh as they do not believe in the effectiveness of papaya leaves, thus suggesting to patients that they should not use them. In Bangladesh, 1,01,354 dengue patients have been hospitalized, with 179 deaths in the year 2019 according to information from the Institute of Epidemiology, Disease Control, and Research as well as the Directorate General of Health Services of Bangladesh. Most of the patients died because of the falling down of platelets to dangerous levels and hemorrhage or serious bleeding. Therefore, this paper aims to critically review the scientific basis and effectiveness of Carica papaya L. leaves in treating dengue fever based on preclinical and clinical reports. Thrombocytopenia is one of the major conditions that is typical in cases of dengue infection. Besides, the infection and impairment of immunity are concerned with dengue patients. This review summarizes all the scientific reports on Carica papaya L. for its ability on three aspects of dengue: antiviral activities, prevention of thrombocytopenia and improvement of immunity during dengue fever.

Matched MeSH terms: Physicians
Fulltext Clinical pathways: development and implementation at a tertiary hospital in Malaysia

Aniza Ismail, Saperi Sulung, Syed Mohamed AlJunid, Nor Hamdan Mohd Yahaya, Husyairi Harunarashid, Oteh Maskon, et al.

Int J Public Health Res, 2012;2(2):153-160.
MyJurnal

Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Physicians
Fulltext Risk factors for diabetic retinopathy in diabetic screened using fundus photography at a primary health care setting in East Malaysia

Mallika PS, Lee PY, Cheah WL, Wong JS, Syed Alwi SAR, Nor Hayati H, et al.

Malays Fam Physician, 2011;6(2):60-65.
MyJurnal

Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia

Matched MeSH terms: Physicians, Family
An analysis of inter-professional collaboration in osteoporosis screening at a primary care level using the D'Amour model

Toh LS, Lai PSM, Othman S, Wong KT, Low BY, Anderson C

Res Social Adm Pharm, 2017 11;13(6):1142-1150.
PMID: 27780658 DOI: 10.1016/j.sapharm.2016.10.004

OBJECTIVES: This study describes the perspective of patients, nurses, pharmacists, doctors and policy makers to identify the level of collaboration and the areas for improvement to achieve inter-professional collaboration between doctors, nurses, pharmacists and policy makers in a primary care clinic.

METHODS: Patients (n = 20), Nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) from a primary care were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis informed by constant comparison.

RESULTS: Patients, doctors, nurses, pharmacists and policy makers were eager for pharmacists to be more proactive in creating health awareness and conducting osteoporosis screening at the primary care clinic via inter-professional collaboration. These findings were further examined using the D'Amour's structural model of collaboration which encompasses four main themes: shared goals and visions, internalization, formalization and governance. This model supports our data which highlights a lack of understanding of the pharmacists' role among the doctors, nurses, policy makers and pharmacists themselves. There is also a lack of governance and formalization, that fosters consensus, leadership, protocol and information exchange. Nonetheless, the stakeholders trust that pharmacists have sufficient knowledge to contribute to the screening of osteoporosis. Our primary care clinic can be described as developing towards an inter-professional collaboration in managing osteoporosis but is still in its early stages.

CONCLUSIONS: Inter-professional collaboration in osteoporosis management at the primary care level is beginning to be practised. Efforts extending to awareness and acceptance towards the pharmacists' role will be crucial for a successful change.

Matched MeSH terms: Physicians
Fulltext Hepatitis B infection: what the primary care doctors should know

Kew ST, Loh KY

Malays Fam Physician, 2006;1(1):8-10.
MyJurnal

Hepatitis B virus infection is a global public health problem. The prevalence of hepatitis B infection is higher in Asia. The rate of HBsAg carriage in the general population ranges from 2-20%. The WHO has recommended that by the end of 21st century hepatitis B vaccination should be incorporated into routine childhood immunisation programmes for all nations. Vaccination against hepatitis B remains the most important aspect of preventive care. Most importantly hepatitis B vaccination can protect individual from fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. Primary care physicians must be familiar with the pathology, epidemiological and clinical presentations of this disease and be able to refer patients for appropriate treatment at the tertiary centre.

Matched MeSH terms: Physicians, Primary Care
Fulltext Cost analysis of private primary care services hn three urban centres in Malaysia

Syed Mohamed Aljunid, Nyunt-U, Soe, Cheah, Molly, Kwa, S.K., Rohaizat Yon, Ding, L.M.

Malaysian Journal of Public Health Medicine, 2001;1(1):8-15.
MyJurnal

A study was undertaken amongst private primary care providers in three urban centres of Malaysia to understand the organizational structure of the facilities and to assess the cost of running such services. A total of 150 clinics were involved in the study. Data was collected through interviews with owners of the clinics using semi-structured questionnaires. Solo-practitioners owned 64.7% of the clinics while 35.3% of them were owned by group practice. This study showed that the mean number of patients visited the clinics daily was 49.3 with the average operating hours of 79.4 hours/week (range 28.0 - 168.0 hours/week). Group practice clinics operates 23.9 hours longer than solo-practice clinics. Group practice clinics were more likely to offer 24 hours service than solo-practice clinics. Most of the clinics were manned by a single doctor (57.3%), 30.0 % had two doctors and only 12.7% were run by more than two doctors. On average, group practice employed greater number of supporting staff than solo-practice clinics (6.0 vs 4.3 people). The mean annual cost to run each facility was found to be RM 444,698. The mean cost per patient was found to be RM 32.09 for solo-practice clinics and RM 38.55 for group practice. Wages represented the highest proportion in the recurrent cost (61.1%) followed by drugs (29.2%) and consumables (2.7%). Building cost (67.9%) and equipment cost (25.9%) were the major capital costs for the clinics. This study could serve as a basis to reimburse private primary care providers in the future health financing scheme in Malaysia. To improve efficiency and contain cost in primary care settings, efforts should be targeted towards cost of wages and drugs utilised by the providers in their daily practice.
Key words: Private practice; primary care; costs; Malaysia.

Matched MeSH terms: Physicians
Fulltext Economic evaluation of type 2 diabetes management at the Malaysian Ministry of Health primary care clinics, in Machang, Kelantan

Rohana, D., Wan Norlida, W.l., Nor Azwany, Y., Mazlan, A., Zawiyah, D., Che Karrialudin, C.A., et al.

Malaysian Journal of Public Health Medicine, 2007;7(1):5-13.
MyJurnal

Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.

Matched MeSH terms: Physicians, Family
Outbreak of A2-Hong Kong-68 influenza at an international medical conference

Saenz AC, Assaad FA, Cockburn WC

Lancet, 1969 Jan 11;1(7585):91-3.
PMID: 4178014
Matched MeSH terms: Physicians
Fulltext Reducing stigma towards people with mental illness in Malaysia

Lim, Sheri

ASEAN Journal of Psychiatry, 2015;16(2):261-264.
MyJurnal

Mental illness accounts for 12% of the global burden of disease with a reported 1 in 5 Malaysians suffering from a psychological disorder. Sufferers have been long plagued by stigma, which results in social isolation, low-selfesteem, lower opportunities for employment, housing, and ability to achieve life goals. This essay aims to suggest strategies to overcome such stigma in the local setting. Methods: Literature search was conducted through PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar (http://scholar.google.com.my). Data obtained was compiled as an opinion piece. Results: Thefactors contributing to stigma in Malaysia include a lack of public knowledge, language and cultural influences, inaccurate media portrayal, doctors’ attitudes towards the field of psychiatry, and psychiatrists themselves. Stigma can be tackled in four areas: society, media, medical education, and the field of psychiatry. Firstly, psychiatric terminology can be adapted to local languages and cultural beliefs in order to avoid misconceptions. Secondly, public education is more effective if focused to targeted key groups. The media is crucial in influencing the public mind-set, and needs to be creatively engaged. Thirdly, more positive medical practitioner attitudes to mental illness can be moulded through early psychiatric postings during medical school. Finally, psychiatrists play a role in correcting misconceptions, avoiding misdiagnosis and ineffective treatments. Cultural competency leads to better management of patients by awareness towards socio-cultural and religious influences. Conclusion: A multifaceted, united coalition of effort is needed in order to tackle stigma in different contexts, and will require concerted leadership from different parties.

Matched MeSH terms: Physicians
Fulltext Review of ocular injuries in Malaysia

Thevi T, Reddy SC

Malaysian Journal of Public Health Medicine, 2017;17(1):69-77.
MyJurnal

Ocular injuries or trauma to the eye can be caused by variety of objects resulting in a spectrum of lesions in the eye. We did a Pubmed/Google/Science Direct search to review the spectrum of ocular injuries in Malaysia. In our review, we included 28 papers providing information on ocular injuries which were published from Malaysia during the period 1991-2016 in different medical journals. Prevalence was more among males with an average age of 35 years. Among adults they were more common in the workplace but in children it occurred at home. Few wore protective glasses at work. The mode of injury was due to sharp objects hitting the eye, motor vehicle and domestic accidents, firecrackers, chemicals and rarer causes like superglue and durian fruit. Prognostic factors for outcome were the initial visual acuity, length of the wound, associated factors like hyphaema, intraocular foreign body and vitreous prolapse. Missing the diagnosis of perforation of the eyeball is possible without eliciting a proper history. Protective devices must be worn to prevent injuries. Display of health education charts showing the effect of injuries in the eye and their preventive measures in health centres, private hospitals, schools, factories and sports centres will increase the awareness of public about the ocular injuries. It is important to diagnose the tissues involved in ocular trauma by the general practitioners and primary care physicians and refer the patients to the Ophthalmologist urgently for treatment to salvage vision. Compensation mechanisms should then be put forth in terms of rehabilitation and for monetary loss.

Matched MeSH terms: Physicians, Primary Care
Fulltext Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma

Lim WY, Turner RM, Morton RL, Jenkins MC, Irwig L, Webster AC, et al.

BMC Health Serv Res, 2018 06 20;18(1):477.
PMID: 29925350 DOI: 10.1186/s12913-018-3291-7

BACKGROUND: Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma.
METHODS: We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort.
RESULTS: Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend

Matched MeSH terms: Practice Patterns, Physicians'
Fulltext The intention to disclose medical errors among doctors in a referral hospital in North Malaysia

Hs AS, Rashid A

BMC Med Ethics, 2017 01 23;18(1):3.
PMID: 28114911 DOI: 10.1186/s12910-016-0161-x

BACKGROUND: In this study, medical errors are defined as unintentional patient harm caused by a doctor's mistake. This topic, due to limited research, is poorly understood in Malaysia. The objective of this study was to determine the proportion of doctors intending to disclose medical errors, and their attitudes/perception pertaining to medical errors.
METHODS: This cross-sectional study was conducted at a tertiary public hospital from July- December 2015 among 276 randomly selected doctors. Data was collected using a standardized and validated self-administered questionnaire intending to measure disclosure and attitudes/perceptions. The scale had four vignettes in total two medical and two surgical. Each vignette consisted of five questions and each question measured the disclosure. Disclosure was categorised as "No Disclosure", "Partial Disclosure" or "Full Disclosure". Data was keyed in and analysed using STATA v 13.0.
RESULTS: Only 10.1% (n = 28) intended to disclose medical errors. Most respondents felt that they possessed an attitude/perception of adequately disclosing errors to patients. There was a statistically significant difference (p

Matched MeSH terms: Physicians
Generic medicines utilizations and generic prescribing in Nepal: A reflection of current scenario and possible solutions

Ansari M, Humagain B, Hassali MA

Res Social Adm Pharm, 2017 02 01;13(3):658-659.
PMID: 28162993 DOI: 10.1016/j.sapharm.2017.01.004
Matched MeSH terms: Practice Patterns, Physicians'
Fulltext Melioidosis in acute cholangitis of diabetic patient: a forgotten diagnosis

Mohamad N, Ponnusamy S, Devi S, Manikam R, Idrus II, Bakar NHA

Res Rep Trop Med, 2012;3:103-106.
PMID: 30100777 DOI: 10.2147/RRTM.S34483

Melioidosis presents with a wide range of clinical presentations, which include severe community-acquired pneumonia, septicemia, central nervous system infection, and less severe soft tissue infection. Hence, its diagnosis depends heavily on the clinical microbiology laboratory for culture. In this case report, we describe an atypical presentation of melioidosis in a 52-year-old man who had fever, right upper-abdominal pain, and jaundice for 15 days. Melioidosis caused by Burkholderia pseudomallei was subsequently diagnosed from blood culture. As a primary care physician, high suspicion index is of great importance. High suspicion index of melioidosis in a high-risk group patient, such as the patient with diabetes mellitus and diabetic foot, is crucial in view of atypical presentations of pseudomonas sepsis. A correct combination of antibiotic administration in the early phase of therapy will determine its successful outcome.

Matched MeSH terms: Physicians, Primary Care
Fulltext Perspectives of health professionals towards deprescribing practice in Asian nursing homes: a qualitative interview study

Kua CH, Mak VS, Lee SWH

BMJ Open, 2019 10 11;9(10):e030106.
PMID: 31604786 DOI: 10.1136/bmjopen-2019-030106

OBJECTIVE: To examine the determinants of deprescribing among health professionals in nursing homes, focusing on knowledge, practice and attitude.
DESIGN: This was a qualitative study comprising semi-structured face-to-face interviews guided by 10 open-ended questions. Interviews were conducted until data saturation was achieved and no new ideas were formed. The interviews were audio-recorded, transcribed verbatim and analysed for themes. To derive themes, we employed directed content analysis of transcript data. Coding was completed using a combination of open, axial and selective coding.
SETTING: Four nursing homes in Singapore.
PARTICIPANTS: The study involved 17 participants (comprising 4 doctors, 4 pharmacists and 9 nurses).
RESULTS: Two key themes were identified, enablers and challenges. These were enablers and challenges faced by doctors, pharmacists and nurses towards deprescribing. The identified subthemes for enablers of deprescribing were: (1) awareness of medications that are unnecessary or could be targeted for deprescribing; (2) improving quality of life for patients with limited life expectancy; (3) improving communication between doctors, pharmacists and nurses; (4) systematic deprescribing practice and educational tools and (5) acknowledgement of possible benefits of deprescribing. The identified subthemes for challenges of deprescribing were: (1) symptoms not acknowledged as possibly drug-related; (2) lack of knowledge in patient's and family members' preferences; (3) lack of coordination between health professionals in hospitals and nursing homes and (4) limited tools for deprescribing. The development of a local guideline, mentoring nurses, case discussions, better shared decision-making and improving multidisciplinary communication, may help to support the process of deprescribing.
CONCLUSION: In conclusion, this study highlighted that deprescribing in the nursing homes is perceived by health professionals to be challenging and future research could assess how routine case studies, mentoring and better multidisciplinary communication could improve deprescribing knowledge and process in the nursing homes.

Matched MeSH terms: Physicians

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