Displaying publications 61 - 80 of 266 in total

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  1. Goh SG, Rusli BN, Khalid BA
    Asia Pac J Clin Nutr, 2015;24(2):190-8.
    PMID: 26078234 DOI: 10.6133/apjcn.2015.24.2.04
    Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Current studies have shown that lowering glycosylated haemoglobin (HbA1c) confers protection against microvascular complications. However, with more intensive glucose control to achieve HbA1c of less than 6.5%, there seems to be a significant increased risk of mortality and cardiovascular events. The current recommendation worldwide is for "tailoring" of DM management to risk and also quality of Life (QOL) which is a crucial component in determining the success or failure of DM management. In Asia, DM has become a health crisis but there is a lack of QOL assessment tool that is specific for Asians with wide spectrum of ethnicity, languages, religions and socio-economic differences. In this review, we discuss the evolution of DM management over the decade and the issues pertaining to QOL among people living with diabetes in Asia.
  2. Goh SG, Rusli BN, Khalid BA
    Diabetes Res Clin Pract, 2015 Jun;108(3):489-98.
    PMID: 25790899 DOI: 10.1016/j.diabres.2015.02.009
    To construct a type-2 diabetes specific quality of life (QOL) tool for Asian populations that is valid and reliable across different ethnicities, languages, and socio-economic backgrounds.
  3. Joginder Singh S, Chan MY, Ahmad Rusli Y
    Int J Speech Lang Pathol, 2016 12;18(6):560-570.
    PMID: 27063683
    PURPOSE: Children with speech and language delay/disorder (SLD) in the developing language stage (DLS) are one of the largest populations served by speech-language pathologists (SLPs) working in paediatric settings. The aim of this study was to investigate the practise patterns adopted by Malaysian SLPs when managing these children.

    METHOD: A web-based questionnaire was developed to obtain information about SLPs' practises during assessment, planning and treatment.

    RESULT: A total of 53 SLPs completed the questionnaire. When assessing the children, participants either always or usually involved parents, suggesting that they understood the importance of family involvement in services provided. When planning goals, the SLPs relied mostly on their clinical experience and less on research evidence. Participants reported that, most often, they employed a one-to-one approach when providing treatment. There was, however, great variation in the frequency of treatment provided, reflecting the different workplaces of participants.

    CONCLUSION: Generally, findings from this study indicated that some practises employed by Malaysian SLPs when managing children with SLD in the DLS are on par with the best practise guidelines, but there is still room for improvement in certain areas such as team collaboration and evidence-based practise. Clinical and research implications are discussed.

  4. Joginder Singh S, Suhumaran LV, Skulski K, Ahmad Rusli Y
    Augment Altern Commun, 2022 Dec;38(4):236-244.
    PMID: 36573041 DOI: 10.1080/07434618.2022.2141135
    Most speech-language pathologists (SLPs) in Malaysia practice with an undergraduate degree, which provides them with limited knowledge about and training in augmentative and alternative communication (AAC). This limited knowledge and training may affect their confidence and competence when introducing and using AAC with individuals for whom it is required. This study aimed to obtain feedback, via semi-structured interviews, from a group of 11 Malaysian university students who participated in an AAC training program about their experiences participating in and the effectiveness of the training program. Three themes were derived from qualitative content analysis of the interviews: (a)Time Demands, (b) Generalizing the use of AAC, and (c) Learning Required When Introducing AAC. The participants reported that they obtained better insights into the role of SLPs and communication partners with regards to AAC, as well as the struggles they faced. Students also reported increased confidence when working with individuals who use AAC after participating in the training program, thus supporting the need for similar training programs in the future.
  5. Jasmani L, Jamaluddin NAN, Rusli R, Adnan S, Zakaria S
    Polymers (Basel), 2022 Oct 28;14(21).
    PMID: 36365585 DOI: 10.3390/polym14214591
    Nanocellulose is a versatile cellulosic nanomaterial that can be used in many application areas. Applying different preparation strategies leads to different types of nanocellulose. In this study, nanocrystalline cellulose (NCC) and nanofibrillated cellulose (NFC) were prepared from lesser known wood species, viz., Macaranga gigantea, using sulfuric acid hydrolysis and enzymatic pretreatment with ultrafine grinding approaches, respectively. The respective nanocellulose was characterized by means of Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) analysis, thermogravimetric analysis (TGA), atomic force microscopy (AFM). It was then converted into a thin film to assess its performance which includes tensile test, transparency, air permeance, water vapor transmission rate (WVTR), and water vapor permeability (WVP) properties. NCC and NFC produced from the raw material of Macaranga had average widths of 6.38 ± 3.92 nm and 13.17 ± 12.71 nm, respectively. Peaks in FTIR spectra showed the conversion of Macaranga wood to nanocellulose by the presence of cellulose fingerprint as well as absence of lignin and hemicellulose after alkaline treatment. The successful conversion was also supported by XRD analysis which displayed the increased crystallinity value from 54% to 70%. TGA decomposition pattern at 200-490 °C revealed the thermal stability of the samples. The thin film produced from nanocelluloses had WVTR values of 4.58 and 12.14 g/(day·m2) for NFC and NCC, respectively, comparable to those of films from polyester and oriented polypropylene. Nanocellulose-based thin film has the potential to be used as sustainable and biodegradable packaging.
  6. Rusli RA, Makmor Bakry M, Mohamed Shah N, Hui Jan T
    Epilepsy Behav, 2023 Mar 29;142:109154.
    PMID: 37001468 DOI: 10.1016/j.yebeh.2023.109154
    INTRODUCTION: Seizure outcomes from antiseizure medication (ASM) therapy can be measured across various domains using assessment tools. The available tools may contain an array of different components or items. Seizure severity assessment, as opposed to seizure frequency count may have been a more accurate measurement in determining the effectiveness of ASM therapy. This study aimed to review studies developing seizure severity assessment tools for adults with epilepsy, describe the development methods and validation, and compare the list of items in these tools.

    METHODS: The systematic search utilized established databases such as Scopus, Ovid, Web of Science, Medline, Wiley Online, and Cochrane Library. Studies published from inception to December 15, 2022, were selected. Publications describing the development of tools to measure seizure severity among adult epilepsy patients were included. Outcome measures including the tool's content, development methods, validity, and reliability assessments were compared.

    RESULTS: The search produced eight publications describing the development of eight seizure severity assessment tools. One of these tools is part of a multidimensional assessment of the overall impact of epilepsy. The frequently used method in the initial development was the qualitative method (n = 6) where two publications reanalyzed the items from previous studies. Face validity was the most common validation test conducted (n = 4). At least one reliability assessment was conducted for each of the tools, most commonly by the test-retest method (n = 6) and inter-rater reliability (n = 5). All of these tools cover the components of pre-ictal (warning/aura), ictal, and postictal (recovery) events.

    CONCLUSION: The identified tools described the assessment of seizure severity using various subscales. The emergence of new methods in quantifying seizure severity unfolds opportunities in discovering more comprehensive assessments of seizure severity in both clinical trials and daily clinical practice.

  7. Jamil SNAM, Daik R, Ahmad I
    Materials (Basel), 2014 Sep 01;7(9):6207-6223.
    PMID: 28788187 DOI: 10.3390/ma7096207
    A synthesis of acrylonitrile (AN)/butyl acrylate (BA)/fumaronitrile (FN) and AN/EHA (ethyl hexyl acrylate)/FN terpolymers was carried out by redox polymerization using sodium bisulfite (SBS) and potassium persulphate (KPS) as initiator at 40 °C. The effect of comonomers, BA and EHA and termonomer, FN on the glass transition temperature (Tg) and stabilization temperature was studied using Differential Scanning Calorimetry (DSC). The degradation behavior and char yield were obtained by Thermogravimetric Analysis. The conversions of AN, comonomers (BA and EHA) and FN were 55%-71%, 85%-91% and 76%-79%, respectively. It was found that with the same comonomer feed (10%), the Tg of AN/EHA copolymer was lower at 63 °C compared to AN/BA copolymer (70 °C). AN/EHA/FN terpolymer also exhibited a lower Tg at 63 °C when compared to that of the AN/BA/FN terpolymer (67 °C). By incorporating BA and EHA into a PAN system, the char yield was reduced to ~38.0% compared to that of AN (~47.7%). It was found that FN reduced the initial cyclization temperature of AN/BA/FN and AN/EHA/FN terpolymers to 228 and 221 °C, respectively, in comparison to that of AN/BA and AN/EHA copolymers (~260 °C). In addition, FN reduced the heat liberation per unit time during the stabilization process that consequently reduced the emission of volatile group during this process. As a result, the char yields of AN/BA/FN and AN/EHA/FN terpolymers are higher at ~45.1% and ~43.9%, respectively, as compared to those of AN/BA copolymer (37.1%) and AN/EHA copolymer (38.0%).
  8. Dhillon H, Nordin RB, Ramadas A
    PMID: 31547629 DOI: 10.3390/ijerph16193561
    Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia's unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8-18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3-8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5-39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1-32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.
  9. AlMeman AA, Ismail R, Perola M
    Drug Metab Lett, 2016;10(3):213-218.
    PMID: 27515451
    INTRODUCTION: Methadone is accepted as an alternative therapy in opioid use disorders worldwide. Methadone responsiveness, however, is affected by a range of CYP450 enzymes and OPRM1 polymorphisms.

    OBJECTIVE: This study sought to detect CYP2B6 and OPRM1 variants and their genotypes, as major contributors to inter-variability in methadone responsiveness and methadone dose requirements.

    METHODS: We carried out a prospective experimental one-phase pharmacogenetic study in four addiction clinics in Malaysia. Patients on stable methadone maintenance therapy were recruited. The prevalence of the CYP2B6 and OPRM1 polymorphisms was determined using a nested polymerase chain reaction (PCR), followed by genotyping. A two-step multiplex PCR method was developed to simultaneously detect the 26 SNPs in these two genes.

    RESULTS: 120 males were recruited for this study. The patients were between 21and 59 years old, although the majority of the patients were in their 30s. C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1 were found to be polymorphic, and the allelic frequencies of each were calculated. We further detected eight new haplotypes.

    CONCLUSION: C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1were found to be polymorphic. The new haplotypes may give a new insight on methadone clinics.

  10. Thomas S, Beh L, Nordin RB
    J Public Health Afr, 2011 Sep 05;2(2):e23.
    PMID: 28299064 DOI: 10.4081/jphia.2011.e23
    Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care.
  11. Nordin RB, Rahman Bin Isa A, Rusli Bin Abdullah M
    Malays J Med Sci, 2001 Jul;8(2):9-13.
    PMID: 22893754 MyJurnal
    The prevalence of sexually transmitted diseases (STD) among female drug abusers was studied by screening 130 new inmates of a rehabilitation centre. Data was collected using a structured questionnaire, physical examination and specimen collection for laboratory investigation at the Community Medicine Clinic of HUSM. The majority (64.6%) were Malays and self-confessed sex workers (77.7%). A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%), trichomoniasis (19.2%) and gonococcal vaginitis (8.5%) was noted. More than half of them harbour 2 or more STDs. Six subjects, of whom 5 were Malays, were HIV positive. The evidence indicates that female drug abusers need a thorough screening for STD followed by an aggressive treatment regimen. Since the majority of them were born Muslims, they should have access to spiritual counselling and rehabilitation, stressing on repentance, and adopting a compassionate and forgiving approach.
  12. Omar J, Jaafar Z, Abdullah MR
    Malays J Med Sci, 2009 Jan;16(1):44-7.
    PMID: 22589648 MyJurnal
    A cross sectional pilot study was carried out to look into the usefulness of percent free prostate specific antigen (fPSA) in the diagnosis of prostatic cancer in HUSM patients. All patients who attended surgical clinic and admitted to surgical wards with signs and symptoms of prostate problems during the study period were taken as the study subjects. Total prostate specific antigen (tPSA) was estimated by immunoassay technique and those values of 4 ng/mL or more were proceeded for estimation of fPSA. Using the cut-off value of less than 25% fPSA for diagnosing patients with prostate cancer, our study showed that majority of the prostate cancer patients have a ratio of fPSA:tPSA more than 25% and a significantly higher level of total prostate specific antigen (P<0.005) when compared with patients with benign prostatic hyperplasia (BPH). Unexpectedly, the fPSA values were high in patients diagnosed as prostate cancer compared to BPH. Ratio of percent fPSA to tPSA was found not to be sensitive and specific, in diagnosing prostate cancer at the cut-off value of 25%. In conclusion, total PSA is a more useful biochemical test for diagnosing prostate cancer in our patients.
  13. Al-Joudi FS, Iskandar ZA, Rusli J
    Med J Malaysia, 2008 Jun;63(2):96-9.
    PMID: 18942291
    The p53 gene is a tumour suppressor gene that encodes a 393-amino-acid nuclear DNA-binding phosphoprotein. The significance of p53 detection is that p53 mutation is linked with chemo-resistance and transformation to more aggressive disease in a large number of tumour types and it was confirmed that mutant p53 is involved in neoplastic transformations. In addition, the expression of p53 has been closely correlated with clinicopathological findings. Since breast cancer has been reported as one of the most frequent malignancies in women in Malaysia, the expression of p53 was studied in 382 cases of invasive ductal carcinoma of the breast, obtained from three major hospitals in the North-East States of Malaysia. The study utilized an enzyme immunohistochemistry assay for the detection of p53. It was found that p53 was expressed in 29.6% of all the study cases. Furthermore, its expression was significantly correlated with the age and the clinical grading of the disease. No significant statistical correlations were depicted with lymph node status, tumour size, side of tumour, and expression of estrogen and progesterone receptors. Nevertheless, knowledge of the p53 status may be valuable in making clinical decisions regarding diagnosis, prognosis and therapy.
  14. Xervaser, Arene Ursolo, Rusli Ahmad, Nur Fatihah Abdullah Bandar, Siti Mariam Abdullah
    MyJurnal
    This study aims to identify employee perceptions of perceived fairness in performance appraisal system and work performance as the performance appraisal system is crucial to evaluate employees’ performance in every organization; public or private. A private Oil & Gas company in Miri, Sarawak was chosen for this study. Quantitative research method was employed in this study, and closed-ended questionnaires were used to collect data from respondents. Statistical analysis using One Way ANOVA, Pearson correlation, and Independent sample t-test were used to test the hypotheses. The findings showed that there were no significance differences between the selected demographic factors (age, gender, duration of service, highest educational level, and rank) in performance appraisal system and the work performance. Also, there was a significant relationship between the rating accuracy in the performance appraisal system and work performance. Besides that, there was a significant relationship between employee perceptions of leadership styles in decision making in the performance appraisal system and work performance. The findings also showed that employees are concerned with the evaluation and rating given by their supervisor because the outcomes of the performance appraisal will influence their career development in the organization. Thus, performance appraisal system is crucial in increasing the work performance of employees and organization. Organizations should emphasize the role of the performance appraisal system practiced in their organizations and recognize that it is important in improving employees’ performance. Future researchers are encouraged to explore further on the performance appraisal elements that have not been investigated in this study, and conduct the research with a bigger population and sample size.
  15. Aslina Baharum, Grace Jelang Anak Thomas, Nurul Hidayah Mat Zain, Nordaliela Mohd. Rusli, Jason Teo
    MyJurnal
    An e-learning website is very useful, especially for students and lecturers, as this platform is very efficient for blended learning. Thus, the main objective of this research was to determine the user expectations of e-learning websites of comprehensive universities through localisation based on user preferences. This research showed how users interact with e-learning websites and indicated the patterns that can be used as standard guidelines to design the best e-learning websites. It was found localisation of e-learning websites was scarce and slow interaction with e-learning websites has inconvenienced users. Additionally, too many web objects on the user interface of e-learning websites have a tendency to confuse users. A mixed method approach was used I this study, namely content analysis (qualitative) and localisation (quantitative). Thus, this research contributes to knowledge by guiding users on localising their web objects according to their preferences and hopefully allow for an easy and quick information search for e-learning websites.
  16. Nurul Izni Rusli, Mastura Shafinaz Zainal Abidin, Budi Astuti, Ali NK, Abdul Manaf Hashim
    Sains Malaysiana, 2013;42:643-648.
    We report the formation of macropores in n-Si (100) substrates for different etching times of 20, 40 and 60 min at a constant current density of 25 mA/cm2 under front-side illumination in HF:ethanol (1:4) solution. After etching for 20 min, four-branch-shaped pores of various sizes were observed at discrete locations. Etching time of 40 min led to the formation of highly connected four-branch-shaped pores as the branches of adjacent pores appeared to connect to each other. As the etching time was increased further to 60 min, the density of interconnected branches increased remarkably. The macropore formation process occurred in three consecutive phases. The current burst model was used to discuss this process. Formation of four-branch-shaped pores at random locations were observed because current bursts are more likely to nucleate where other current bursts took place initially.
  17. Norazlina Noordin, Rusli Ibrahim, Nur Hidayah Mohd Sajahan, Salmah Moosa, Sobri Hussein
    MyJurnal
    Stevia rebaudiana Bertoni is a perennial herb that belongs to the family of Asteraceae. It is a
    natural sweetener plant known as sweet leaf, which is estimated to be 300 times sweeter than cane
    sugar. In this study, micropropagation and in vitro mutagenesis of this natural herb was
    successfully conducted. It was found that shoot tips on MS medium supplemented with 1 mg/l
    Kinetin showed the highest shoot induction and multiplication after 3 weeks of culture
    (5.50±1.95a). Radiosensitivity test was conducted to identify the dose that killed 50% of the
    irradiated explants (LD50) for in vitro stevia shoots and to select effective doses to be used for the in
    vitro mutagenesis. Shoot tips were irradiated with acute and chronic gamma radiation at 0, 10, 20,
    30, 40, 60, and 80Gy. At 60 Gy and 80 Gy, all treated shoot tips were not survived. In this study,
    LD50 for the stevia was estimated at 29 Gy for acute irradiation and 45 Gy for chronic irradiation.
    The effective doses were selected at 10, 20, 30 and 40 Gy. These selected doses were applied for the
    in vitro mutagenesis of the stevia shoots
  18. Noor Aini Hussain, Mohamed Rusli Abdullah, Abdul Rahman Esa, Muzaimi Mustapha, Nasir Yusoff
    ASEAN Journal of Psychiatry, 2014;15(2):164-175.
    MyJurnal
    Objective: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p
  19. Tan, Se Xian, Norhayati Ibrahim, Nuruljannah Johari, Nuruljannah Johari, Roszanadia Rusli, Zahara Abdul Manaf
    MyJurnal
    Obesity is a risk factor for chronic diseases which can affect work productivity and physical function of employees
    particularly among those in security sector. The study aimed to determine the association between obesity with total
    days of sick leave and health related quality of life (HRQoL) among Malay male security officers. A cross-sectional
    study was conducted among Malay male security officers working in a Malaysian higher learning institution. Subjects
    were evaluated using anthropometric measurements, quality of life and number of sick leave taken within two months
    prior to the study. A total of 194 subjects (mean age 40.12 ± 11.41 years) were recruited. A total of 30.4% were obese,
    39.7% were pre-obese and only 29.9% had normal body weight or underweight. Central obesity was observed in 57.7%
    of them and 87.1% shown excessive body fat percentage. Number of sick leave days was positively correlated with Body
    Mass Index (BMI) (r = 0.162, p = 0.024) and waist circumference (r = 0.181, p = 0.012). Score of the general health
    component was negatively correlated with BMI (r = -0.161, p = 0.025), waist circumference (r = -0.194, p = 0.007) and
    body fat percentage (r = -0.191, p = 0.008). Physical functioning score was lowest in obese subjects than normal and
    pre-obese subjects (p = 0.046). Score of the bodily pain component was positively correlated with waist circumference (r
    = 0.156, p = 0.030). Obesity is associated with number of sick leave days and quality of life in the studied group. Hence,
    body weight of the security staff should be monitored and appropriate intervention should be conducted to improve their
    work attendance and quality of life.
  20. Sanus,M,A,, Nordin,M,A,, Rusli,M,R,, Mohamed,Z,N,h,
    Compendium of Oral Science, 2020;7(1):13-19.
    MyJurnal
    Abstract
    Objectives: This study aimed to assess intra- and inter-examiner reliability of International Caries Detection
    and Assessment System (ICDAS) and modified epidemiology ICDAS (MOD) code by undergraduate dental
    students with different clinical experiences.
    Methods: A total of 150 dental undergraduate students with varying clinical experiences (0, 1 and 2 years of
    clinical experience) were recruited. Participants received training through a theoretical lecture on ICDAS criteria
    by an experienced National Benchmark Group (NBG) examiner and underwent e-learning program prior to
    ICDAS calibration. Visual examination on extracted permanent teeth (N= 45) with different location and stages
    of caries progression ranging from ICDAS scores 0 to 6, was performed using the ICDAS criteria. The
    assessments were repeated after one hour. The data were analysed to evaluate inter-examiner and
    intra-examiner reliability in the form of kappa scores using SPSS 23 Software.
    Results: Mean kappa values for intra- and inter-examiner reliability for ICDAS code, were between 0.41 to
    0.60, and 0.61 to 0.80 respectively. For MOD code, mean kappa values for intra- and inter-examiner reliability
    were between 0.61 to 0.80. Good intra-examiner agreement (>0.61) was observed in both ICDAS and MOD
    code for all groups.
    Conclusion: All students performed similar agreement, therefore, clinical experience within 2 years does not
    influence the performance of visual inspection in detecting caries using ICDAS. The results of the study shows
    that ICDAS and modified epidemiology ICDAS codes has good reproducibility and is feasible to be used as a
    tool in clinical practice as well as patient education.
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