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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
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 Rural health care in Malaysia

Ariff KM, Teng CL

Aust J Rural Health, 2002 Apr;10(2):99-103.
PMID: 12047504 DOI: 10.1046/j.1440-1584.2002.00456.x

Malaysia has a population of 21.2 million of which 44% resides in rural areas. A major priority of healthcare providers has been the enhancement of health of 'disadvantaged' rural communities particularly the rural poor, women, infants, children and the disabled. The Ministry of Health is the main healthcare provider for rural communities with general practitioners playing a complimentary role. With an extensive network of rural health clinics, rural residents today have access to modern healthcare with adequate referral facilities. Mobile teams, the flying doctor service and village health promoters provide healthcare to remote areas. The improvement in health status of the rural population using universal health status indicators has been remarkable. However, differentials in health status continue to exist between urban and rural populations. Malaysia's telemedicine project is seen as a means of achieving health for all rural people.

Matched MeSH terms: Physicians/supply & distribution
Fulltext Evaluation of awareness & utilisation of clinical practise guideline for management of adult dengue infection among Malaysia doctors

Ariff MI, Yahya A, Zaki R, Sarimin R, Mohamed Ghazali IM, Gill BS, et al.

PLoS One, 2017;12(5):e0178137.
PMID: 28562626 DOI: 10.1371/journal.pone.0178137

Clinical Practice Guideline (CPG) provides evidence-based guidance for the management of Dengue Infection in adult patients. A cross sectional study was conducted to evaluate awareness and utilization of CPG among doctors in public or private hospitals and clinics in Malaysia. Doctors practicing only at hospital Medical and Emergency Departments were included, while private specialist clinics were excluded in this study. A multistage proportionate random sampling according to region (Central, Northern, Southern, Eastern, Sabah and Sarawak) was performed to select study participants. The overall response rate was 74% (84% for public hospitals, 82% for private hospitals, 70% for public clinics, and 64% for private clinics). The CPG Awareness and Utilization Feedback Form were used to determine the percentage in the study. The total numbers of respondent were 634 with response rate of 74%. The mean lengths of service of the respondent were 13.98 (11.55).A higher percentages of doctors from public facilities (99%) were aware of the CPG compared to those in private facilities (84%). The percentage of doctors utilising the CPG were also higher (98%) in public facilities compared to private facilities (86%). The percentage of Medical Officer in private facilities that utilizing the CPG were 84% compares to Medical Officer in public facilities 98%. The high percentage of doctors using the CPG in both public (97%) and private (94%) hospitals were also observed. However, only 69% of doctors in private clinics utilised the CPG compared to doctors in public clinics (98%). Doctors in both public and private facilities were aware of the dengue CPG. However, most doctors in private clinic were less likely to utilise the CPG. Therefore, there is a need to increase the level of CPG utilisation especially in private clinics.
Study site: primary care and hospital from Medical and Emergency Department, public and private health facilities in Malaysia

Matched MeSH terms: Practice Patterns, Physicians'*
A survey of the primary care management of osteoarthritis in Malaysia: A view from a rheumatologist's perspective

Arshad A, Rashid R, Das Gupta E

Int J Rheum Dis, 2008;11(3):246-250.
DOI: 10.1111/j.1756-185X.2008.00367.x

Objective: Primary care management of knee osteoarthritis (OA) has received little attention in the scientific literature and the main reason for this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting.
Methods: A cross-sectional survey of 200 randomly selected general practitioners (GPs) in the peninsular states of Malaysia was undertaken using a questionnaire. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment. They were also asked about their usage of conventional and complementary medication.
Results: One hundred and eighty (90%) GPs responded to the questionnaires sent: 77% were in solo practice and 33% in group practice. Most of the GPs surveyed (60%) had been in practice for more than 10 years, 30% for 5-10 years and 10% were in practice for less than 5 years. Of GPs surveyed, 55% saw an average of more than 20 patients per week, 35% about 10-20 patients and 10% less than 10 patients per week. Of GPs surveyed, 65% would arrange an X-ray, 55% would arrange a blood test, mostly serum uric acid, rheumatoid factor and erythrocyte sedimentation rate. Pharmacological management consists of first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs) (61%), analgesics (35%) or a combination of the two (4%). Non-pharmacological management consisted of advice on exercise (27%), weight reduction (33%) and referral to physiotherapy (10%). Of GPs surveyed, 85% prescribed some form of complementary medications, 60% prescribed glucosamine sulphate, 21% chondroitin sulphate, 11% cod liver oil and 9% evening primrose oil. Only 10% of GPs surveyed perform intra-articular injections.
Conclusion: The data suggest that in the primary care setting, the majority of GPs over-investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesics and NSAIDs. The use of physiotheraphy and non-drug approaches were significantly under-utilized. There is a need to further educate GPs in the management of OA.

Matched MeSH terms: Physicians, Family
Fulltext Awareness and perceptions of fibromyalgia syndrome: a survey of Malaysian and Singaporean rheumatologists

Arshad A, Kong KO

Singapore Med J, 2007 Jan;48(1):25-30.
PMID: 17245512

INTRODUCTION: Fibromyalgia syndrome (FMS) is a common but controversial condition. There appears to be different levels of belief of its existence and awareness. We set out to explore the variations of perceptions and awareness of this condition among rheumatologists from Malaysia and Singapore.
METHODS: 48 rheumatologists from Malaysia (28) and Singapore (20) were approached to participate in this survey by answering a specific questionnaire regarding their belief in FMS. 23 respondents from Malaysia and 20 from Singapore completed the questionnaire.
RESULTS: 91 percent of Malaysian rheumatologists and 95 percent of the Singaporean believe that FMS is a distinct clinical entity and that this condition is considered an illness rather than a disease. 87 percent and 90 percent of rheumatologists from Malaysia and Singapore, respectively, believe that FMS is a mixture of medical and psychological illness. However, not many of those in the university setting include FMS in their undergraduate teaching. 87 percent and 80 percent of the respondents from Malaysia and Singapore, respectively, also ordered blood tests to exclude other serious pathologies, and 100 percent of the respondents from both countries also prescribed some form of drugs to their FMS patients.
CONCLUSION: This study confirmed that there was a variation of perceptions and knowledge of FMS among rheumatologists from Malaysia and Singapore. The majority of rheumatologists recognise that FMS is a distinct clinical entity, and is diagnosed by excluding other well-defined clinical diseases through a combination of clinical evaluation and screening tests.

Matched MeSH terms: Practice Patterns, Physicians'
Fulltext Tears of a Physician, are they justified?

Arshad S, Min Allah NU, Khamis MF

J Pak Med Assoc, 2020 Jul;70(7):1293.
PMID: 32799286 DOI: 10.5455/JPMA.59669
Matched MeSH terms: Physicians*
Some aspects of the sterilization program in Malaysia

Arshat H, Ali J, Noor Laily Abu Bakar

Malays J Reprod Health, 1984 Jun;2(1):1-13.
PMID: 12267515
Matched MeSH terms: Physicians
Office laparoscopic assessment of female fertility

Arshat H, Yuliawiratman, Piliang AS

Malays J Reprod Health, 1983 Jan;1(1):46-54.
PMID: 12279889

This preliminary report details our experience and also serves to evaluate the risk benefits of office laparoscopy for female fertility assessment in 183 subjects. The patients were admitted at about 8.00 in the morning and discharged at 3.00 to 4.00 in the afternoon after laparoscopy has been performed. Only 7. 7 percent of the subjects required inhalational anesthetic gases along with a combination of intravenous sedation and local anesthetic infiltration. The pick-up rate for pelvic abnormality is fairly high, approximately 22.4 percent. Difficulties and complications encountered during laparoscopy were minimal and easily overcome. The benefits of laparoscopy overrules the risk of complications. It is suggested that all family planning clinics involved in fertility assessment and sterilization feature laparoscopy on an but patient basis as one of its main activities.

Matched MeSH terms: Physicians
Fulltext Pilomatrixoma: a diagnostic pitfall on fine-needle aspiration cytology of benign ‘Neck Metastases’

Asha’ari ZA, Shiyuti MI, Abdullah K, Selimin A, Sathananthar KS

International Medical Journal Malaysia, 2014;13(2):63-66.
MyJurnal

Pilomatrixoma is a benign tumour that originates from the matrix of the hair root. This rare tumour is usually managed by the dermatologists. The commonest location of this tumour is in the head and neck region; hence, it can be encountered by any doctors with interest in this area. When presented in the neck, this hard tumour may pose a diagnostic challenge. A case report of pilomatrixoma misdiagnosed as a metastatic neck disease from fine-needle aspiration cytology is presented. The mistake in the diagnosis has led to a more aggressive and high morbidity surgery than necessary. It is important that head and neck doctors be aware of this condition and includes it in the differential diagnosis of hard masses presenting in the neck.

Matched MeSH terms: Physicians
Fulltext Roles of primary care physicians in managing bipolar disorders in adults

Awaluddin A, Jali N, Bahari R, Jamil Z, Haron N

Malays Fam Physician, 2015;10(3):27-31.
PMID: 27570605 MyJurnal

Management of bipolar disorder (BD) is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

Matched MeSH terms: Physicians, Primary Care
Fulltext Factors influencing H1N1 vaccination among primary health care workers: A cross-sectional study

Aziz NA, Muhamad S, Manaf MR, Hamid MZ

Int J Prev Med, 2013 Jun;4(6):664-70.
PMID: 23930184

BACKGROUND: Primary health care workers (PHCW) are the front-liners in any infectious disease outbreaks. The recent outbreak of H1N1 influenza demonstrated that uptake of H1N1 vaccination remained low amongst PCHW despite its proven effectiveness. This trend is worrying as PHCW are the first point of contact in any emerging outbreak of future influenza epidemic. To investigate factors influencing willingness of H1N1 vaccination amongst PHCW.
METHODS: A cross-sectional survey using self-reported questionnaire assessing perception and practice towards H1N1 Influenza A vaccination. A score of 34/50 was used as a cut-off score that divide good and poor perception. Logistic regression analysis used to explore the association between acceptance to be vaccinated and chosen variables.
RESULTS: The mean age was 33.91 (SD: 8.20) with mean year of service of 9.23 (SD: 8.0). Acceptance of H1N1 vaccination was 86.3%. A total of 85.9% perceived the vaccination can prevent serious disease. Willingness to be vaccinated influenced by perception at risk of having illness (OR: 10.182, CI: 1.64-63.23, P 0.013) and need for vaccination (OR: 11.35, CI: 4.67-27.56, P < 0.0001).
CONCLUSIONS: PCHW were generally willing to be vaccinated should H1N1 Influenza epidemic emerges in the future. However, acceptance of vaccination was influenced by factors of benefit to prevent illness and reduction of spread of the illness. Fear of side-effects remained a barrier toward acceptance which should be taken into account in planning of preparation for future wave of outbreak.

Matched MeSH terms: Physicians, Primary Care
Herbal medicines: predictors of recommendation by physicians

Aziz Z

J Clin Pharm Ther, 2004 Jun;29(3):241-6.
PMID: 15153085

We hypothesized that as the use of herbal medicines increases in the general population, so do patients' requests to physicians for recommendations. However, why some physicians recommend herbal medicines while others do not is not well understood.

Matched MeSH terms: Practice Patterns, Physicians'/trends*; Physicians/statistics & numerical data
Fulltext Self-perceived anxiety symptoms and its associated factors among type 2 Diabetic patients in rural communities of Malaysia

Azlina Wati Nikmat, Mohd Ariff Fadzil, Sakinah Idris

Journal of Clinical and Health Sciences, 2016;1(2):11-17.
MyJurnal

Introduction: Little is known about anxiety symptoms among diabetic patients, especially among those who are living in rural areas in Malaysia. Thus, the aim of this paper is to investigate the prevalence of anxiety among diabetic patients and factors associated with anxiety in rural communities in Malaysia. Methods: A cross-sectional study involving 464 diabetes mellitus patients in rural health districts and outpatient clinics in Malaysia was conducted. Each participant was interviewed using the Hospital Anxiety and Depression Scale. Results: Respondents consisted of 193 (41.6%) males and 271 (58.4%) females. The mean age of participants was 59.65 ± 10.16 years and the mean duration of diabetes mellitus was 6.9 ± 6.3 years. Results indicate that 15% of the participants have anxiety symptoms. Multiple logistic regression analysis revealed that patients with history of ischemic heart disease and depression and those who were underweight have higher anxiety scores with adjusted OR 5.06 (95% CI 1.79 to 14.27), 27.71 (95% CI 14.23 to 53.98) and 14.6 (95% CI 2.49 to 84.82), respectively. Conclusions: This study suggests that although the prevalence of anxiety among diabetics is low, primary care physician should be trained to identify high risk patients and to manage their condition in order to improve the clinical outcome.

Study site: rural health districts and outpatient clinics in Malaysia

Matched MeSH terms: Physicians, Primary Care
Fulltext Personal and professional characteristics of a good muslim doctor: perception of newly graduated doctors

Azmi, A.N., Jamilah, J., Dzulkhairi, M.R., Ramli, S., Ariff, O., Nasri Ismai,l N.M.

International Medical Journal Malaysia, 2016;15(2):51-55.
MyJurnal

Introduction: The Medical Faculty of Universiti Sains Islam Malaysia (USIM) aims to produce good Muslim
doctors (GMD) who are able to practise medicine that is integrated with Islamic values. Islamic courses and
Medical Ethics are integrated into the curriculum in its effort to provide adequate Islamic knowledge and
nurturing professionalism as a process of personal and professional development (PPD) within the framework
of Islamic teaching. The objective of the study was to evaluate the perception of graduates and students of
characteristics of a GMD. Method: A self-administered questionnaire was distributed to the participants. The
respondents were asked to rate their level of agreement or disagreement on the statements that represent
the characteristics of a GMD. Statistical analysis of the data was carried out using SPSS version 18.0. The
mean, median and inter quartile ranges of the characteristics were determined and differences between the
groups were analysed using Mann-Whitney U test. Results: Results showed significant difference between
gender for the item “Conscious of professional ethics” (p=0.021). Significant differences were seen in the
median scores between the graduates and the final year students in four out of six items for personal
characteristic. Conclusion: Islamic input in the medical curriculum and the teaching of professionalism has
an impact on graduate perception of characteristics of a GMD. Further improvement in the teaching of
professionalism among undergraduates is necessary in order to promote greater impact on the understanding
and internalization of characteristics of a GMD. The Islamic input in the medical curriculum can thus be
regarded as the blueprint for PPD of medical undergraduates to become a GMD.

Matched MeSH terms: Physicians
Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care

Azmoude E, Aradmehr M, Dehghani F

Malays J Med Sci, 2018 May;25(3):120-128.
PMID: 30899193 DOI: 10.21315/mjms2018.25.3.12

Objectives: Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.
Methods: In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.
Results: The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.
Conclusion: Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

Matched MeSH terms: Physicians
Fulltext Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia

Azraii AB, Ramli AS, Ismail Z, Abdul-Razak S, Badlishah-Sham SF, Mohd-Kasim NA, et al.

BMC Cardiovasc Disord, 2021 01 19;21(1):39.
PMID: 33468051 DOI: 10.1186/s12872-020-01845-y

BACKGROUND: Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP.
METHODS: This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test-retest reliability was tested on 26 PCP using kappa statistics.
RESULTS: During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p

Matched MeSH terms: Physicians, Primary Care
Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training

Azraii AB, Ramli AS, Ismail Z, Abdul-Razak S, Mohd-Kasim NA, Ali N, et al.

Atherosclerosis, 2018 10;277:508-516.
PMID: 30270092 DOI: 10.1016/j.atherosclerosis.2018.08.018

BACKGROUND AND AIMS: This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual).
METHODS: This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP.
RESULTS: A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p 

Matched MeSH terms: Physicians, Primary Care/education*
Fulltext Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners

Bala AA, Jatau AI, Yunusa I, Mohammed M, Mohammed AH, Isa AM, et al.

Toxicon X, 2020 Dec;8:100064.
PMID: 33319211 DOI: 10.1016/j.toxcx.2020.100064

Antisnake venom (ASV) is the only specific and standard treatment for snakebite envenoming worldwide. The knowledge of antivenom dosage, mode of administration, availability, and logistics is essential to the healthcare practitioners (HCPs) in the management of snakebites. It is vital for the HCPs involved in the handling of ASVs to have its basic knowledge. The ASV contains proteins and can, therefore, easily get denatured if not handled appropriately, leading to poor therapeutic outcome. It is also essential for clinicians to be aware of the tendency of ASV to cause a severe life-threatening hypersensitivity reaction. There is currently no validated tool for assessing the knowledge of ASV among HCPs. Therefore, we developed and validated a tool for evaluating the HCPs knowledge of ASV. The items included in the tool were first generated from a comprehensive literature review. Face validity were conducted by presenting the drafted tool to ten experts on the subject matter. A validation study was conducted among doctors, pharmacists, nurses, pharmacy technicians, and the general public. The objectives of the study were to test the tool for content validity using the content validity index (CVI), construct validity using contrast group approach, difficulty index, readability, and reliability test using the test-retest method. We developed and validated a final tool containing thirty-three items. The tool was valid for face validity and had a scale-level (average) content validity (S-CVI/Ave) of 0.91. The ASV knowledge of pharmacists was higher than that of doctors, pharmacy technicians, nurses, and the general public (p

Matched MeSH terms: Physicians
Exploring the knowledge of nasopharyngeal carcinoma among medical doctors at primary health care level in Perak state, Malaysia

Balachandran R, Philip R, Avatar S, Simon R, Mann GS, Benedict CT, et al.

Eur Arch Otorhinolaryngol, 2012 Feb;269(2):649-58.
PMID: 21691719 DOI: 10.1007/s00405-011-1665-0

Nasopharyngeal carcinoma (NPC) is among the commonest cancers in Malaysia. The prognosis for NPC like most other head and neck cancer is dependent on its staging. Majority of patients in Malaysia at the time of diagnosis are either at stage III or IV (27 and 47%, respectively). The lack of knowledge among primary care medical doctors regarding NPC may contribute to this delay in diagnosis. The aim of this study was to assess the knowledge of the primary care doctors in the state of Perak on the various aspects of NPC. The doctors at the primary care level in the state of Perak were recruited to take part in this study on a voluntary basis. A total number of 154 out of 198 doctors participated in this survey. They were given a questionnaire to fill in to test their knowledge on different aspects of NPC and its treatment. The overall respondents' score was poor with a score of 67.5% on all sections. The doctors appear to be able to identify common presenting features of NPC with a mean score of 85.3% but for the uncommon presentations of NPC, the scores were poorer with 61.8%. In addition, 54.1% of the participants answered that they would refer a patient with symptoms suspicious of NPC after a period of 1 month from the onset of symptom. However, only 34% would refer within 2 weeks. Based on the results of this study, the authors feel that it is clear that the doctors posted in the primary care hospitals and clinics appear to have inadequate knowledge to diagnose and refer patients with suspected NPC. As early diagnosis can often lead to a better prognostic outcome, steps must be taken to raise the awareness among these doctors.

Matched MeSH terms: Physicians, Primary Care/education*

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