Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.
The objective of this study was to assess dentists' knowledge and use of evidence-based practice (EBP), including their attitudes toward and perceptions of barriers that limit the use of EBP. A cross-sectional survey was used with self-administered questionnaires involving dental practitioners in the state of Selangor, Malaysia. One hundred ninety-three replies were returned, for a response rate of 50.3 percent. More than two-thirds (135/193, 69.9 percent) of the respondents had heard of EBP. Out of the 135 respondents who had heard of EBP, a majority agreed it was a decision-making process based on evidence (127/135, 94.2 percent) and involved a series of steps from formulating the research question, locating and assessing the evidence, to applying it if suitable (129/135, 95.6 percent). Out of the 135 respondents who had heard of EBP, a high percentage agreed that EBP improved their knowledge and skills (132/135, 97.8 percent) and treatment quality (132/135, 97.8 percent). For advice, a majority of the 135 respondents frequently consulted friends and colleagues (123/135, 91.1 percent), made referrals (120/135, 88.9 percent), consulted textbooks (112/135, 83.0 percent), and referred to electronic databases (90/135, 66.7 percent). Out of the 135 respondents, many perceived EBP as very important (59/135, 43.7 percent) and important (58/135, 43.0 percent) and were interested to learn further information about EBP (132/135, 97.8 percent). The main reported barriers were lack of time (87/135, 64.4 percent), financial constraints (54/135, 40.0 percent), and lack of knowledge (38/135, 28.1 percent). A majority of the 135 respondents had knowledge of and positive attitudes towards EBP. However, due to barriers, a majority of them preferred colleagues, textbooks, and referrals for advice instead of seeking evidence from electronic databases.
When writing scientific papers to share their research findings with their peers, it is not enough for researchers to just communicate the results of their study; it is equally important to explain the process by which they arrived at their results, so that the study can be replicated to validate the observations. The materials and methods section is used to describe the experimental design and provide sufficient details so that a competent colleague can repeat the experiment. A good materials and methods section will enable readers to evaluate the research performed and replicate the study, if necessary.
HbA1c is used for assessing glycaemic control in patients with diabetes. It is also used for treatment goals and as a target for therapeutic intervention. The Direct Control and Complications Trial in the USA showed that HbA1c can be used to predict the risk of complications. Hence, it is important for HbA1c assays to be standardised. The National Glycohemoglobin Standardization Program (NGSP) in the USA was formed in 1996 so that HbA1c results from different laboratories would be comparable to those reported in the DCCT study. There were also HbA1c standardisation programmes in Sweden and Japan. These three standardisation programmes are, in fact, direct comparison methods (DCMs), and yield different HbA1c results. In 1994, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) established a Working Group on Standardisation of HbA1c. This working group has developed a global HbA1c reference system with very much improved intra-assay and inter-assay coefficients of variation. Recommendations have been made to report HbA1c results as IFCC-HbA1c values in SI units (mmol HbA1c/mol Hb) and NGSP-HbA1c (%) as well as estimated average glucose (eAG), once a tight relationship has been shown to exist between eAG and HbA1c.
We review renal registry data from the Asia-Pacific region with an emphasis on their uses in health care and in dialysis care in particular. The review aims to demonstrate the information value of registry data. While renal registry provides a useful data resource for epidemiological research, there are severe methodological limitations in its application for analytical or therapeutic research. However, it is the use of renal registry data for public health and health-care management purposes that registry really comes into its own, and it is primarily for these that governments have invested in national patient and disease registries. We apply data from several renal registries in the Asia-Pacific region to illustrate its wide application for planning dialysis services, for evaluating dialysis practices and health outcomes, with a view to improving the quality of dialysis care. In the course of preparing the review, we have found that the quality and accessibility of renal registry data were highly variable across the region. Given the value of renal registry, every country in the Asia-Pacific region should establish one or should ensure that their current registries are better resourced and developed. Greater data sharing and collaboration among registries in the region could help advance the nephrology to serve our patients better.
This two-part series summarizes 141 postpartum depression studies that have been conducted by nurse researchers from around the globe. Studies contributing to the knowledge base of postpartum depression were conducted in the following nine countries: United States, Australia, Canada, China (Hong Kong, Taiwan), Finland, Iceland, Sweden, Turkey, and Malaysia. Part 1 of this series addressed the contributions of nurse researchers in the areas of epidemiology, risk factors, and transcultural perspectives related to postpartum depression. This article is Part 2, and it describes what nurse researchers have contributed to the following aspects of postpartum depression: instrumentation/screening, interventions, mother-infant interactions, family dynamics, breastfeeding, preterm births, biological factors, clinicians' knowledge, and mothers' use of health services.
Recent development had allowed non-invasive assessment of microvascular function in vivo; however, the method has not been fully optimized and standardized. In this study, we aimed to characterize the "effective" occlusion duration needed to elicit sufficient postocclusive hyperemia (PORH) responses in forearm skin using laser Doppler fluximetry (LDF), in subjects with differing age, gender and menstrual phases.
The purpose of the present study is to provide a critical review on the revolution of the "compliance" concepts from compliance to adherence, and adherence to concordance for both pharmacological and non-pharmacological therapies. A comprehensive literature search was performed using online databases from Library of University Putra Malaysia, and Pub Med based on the keywords. The present study showed that both quantitative and qualitative studies cannot be neglected in assessing adherence and its related problems. One of major findings from the present review is that "compliance" was no longer suitable for current treatments and it is important to define concepts of the terms used (adherence or concordance) correctly and clearly. The findings reflected that researchers placed greater value on medication adherence than non-pharmacological adherence. There were three general factors related to treatments adherence, namely socio-economic factor, treatments-related factor and disease-related factor. The findings showed that both qualitative and quantitative studies found consistent results for most of the factors, except for the experience of diseases symptoms. Both study design contribute important values to the adherence studies and future studies should incorporate both quantitative and qualitative studies to understand adherence in both pharmacological and non-pharmacological treatments.
McIntyre was the first to suggest ranked set sampling (RSS) method for estimating the population mean. In this paper, we modify RSS to come up with new sampling method, namely, two stage ranked set sampling (TSRSS) for samples of size m=3k (k=1,2,..). The TSRSS is suggested for estimating the population median in order to increase the efficiency of the estimators. The TSRSS was compared to the simple random sampling (SRS), ranked set sampling (RSS), extreme ranked set sampling (ERSS), median ranked set sampling (MRSS) and balance groups ranked set sampling (BGRSS) methods. It is found that, TSRSS gives an unbiased estimator of the population median of symmetric distributions and it is more efficient than SRS. Also, it is more efficient than RSS, ERSS, MRSS and BGRSS based on the same number of measured units. For asymmetric distributions considered in this study, TSRSS has a small bias and smaller variance than SRS, RSS, ERSS, MRSS and BGRSS methods.
OBJECTIVES:
Postpartum depression (PPD), a major health concern, produces insidious effects on new mothers, their infant, and family. This literature review aims to explore risk factors for postpartum depression among women in Asian cultures, which has not been fully elaborated.
DATA SOURCES:
A literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they (a) examined risk factors for PPD, (b) were conducted in Asian countries using quantitative or qualitative methodologies, and (c) were published in English in peer-reviewed journals between 1998 and 2008. A total of 64 studies from 17 countries were reviewed, summarised, and synthesised.
RESULTS:
The prevalence of postpartum depression in Asian countries ranged from 3.5% to 63.3% where Malaysia and Pakistan had the lowest and highest, respectively. Risk factors for postpartum depression were clustered into five major groups: biological/physical (e.g., riboflavin consumption), psychological (e.g., antenatal depression), obstetric/paediatric (e.g., unwanted pregnancy), socio-demographic (e.g., poverty), and cultural factors (e.g., preference of infants' gender). Traditional postpartum rituals were not found to provide substantial psychological benefits for the new mothers.
CONCLUSIONS:
This review informs a current state of knowledge regarding risk factors for postpartum depression and has implications for clinical practice. Health care professionals should be aware that the phenomenon is as prevalent in Asian cultures as in European cultures. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions, if needed, can be initiated in a timely fashion.
Superselective embolisation has been recognised as integral in the management of lower gastrointestinal haemorrhage. It has also reduced the need for emergency surgery. The objective of this case series was to describe the lower gastrointestinal haemorrhage cases seen in our centre, its diagnosis and the role of superselective embolisation in patient management.
In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.
A field study was conducted on the effect of four primary tillage implements and three seed densities on the grain yield of rain fed wheat (Tajan cultivar), using a drill planting machine with the end wheels. The experimental design was a split plot design in a 4×3 factorial with three replications. In this study, the main plots were the tillage treatments, namely Mouldboard plough, Disc Plough, Chisel Plough, Offset Disc, and sub-plots were seed rates of 350, 400 and 450 seeds.m-2. Determinations included grain yield and selected yield components. The results showed that grain yield was not affected by the densities of seed and tillage machine treatments. The use of Chisel Plough, with 400 seeds.m-2 sowing rate, had the highest grain yield of wheat grown in the Golestan province (Iran), a region with an average annual rainfall of 450 mm.
The production of carbon dioxide from Karas woods under argon atmosphere was investigated using a direct pyrolysis-combustion approach. Direct burning was used in this study, using argon for yrolysis and oxygen during combustion to look at the yield of carbon dioxide, produced at different parameters, such as the temperature, retention time and flow rate of argon, as the carrier gas. In this study, a new methodology, 23 response surface central composite design was successfully employed for the experimental design and analysis of results. Central composite experimental design and response surface method were utilized to determine the best operating condition for a maximum carbon dioxide production. Appropriate predictable empirical linear model was developed by incorporating interaction effects of all the variables involved. The results of the analysis revealed that linear equation models fitted well with the experimental for carbon dioxide yield. Nevertheless, the R-Squared obtained using the direct pyrolysis-combustion was 0.7118, indicating that the regression line was not at the best-fitted line.
In this study, an anaerobic mesophilic bacterial strain, namely Clostridium butyricum KBH1, was isolated from a natural source. This strain grew well and produced biogas with an average hydrogen concentration of 60% (v/v) in the Reinforced Clostridial Media (RCM). To study the basic nutrient requirements, three main nutrients namely peptone (Pep), yeast extracts (Yes) and glucose (Glu) were chosen as factors, using an experimental design. The experiments were run according to 23 Full Factorial Design, followed by the Response Surface Method (RSM). The fermentation was performed in 30 ml serum bottles with 20 ml working volume in a sterile and anaerobic condition at 37°C with 5% inoculums. The results from the Analysis of Variance (ANOVA) for the factorial design showed that all the three factors had significantly affected the gas production by the C. butyricum. The response surface plot of the gas production by C. butyricum showed that the gas production could be enhanced by increasing peptone and yeast extract concentrations up to 15 g/l and 24 g/l respectively, without showing any substrate inhibition. Meanwhile, the glucose concentration showed an optimum at the middle point (8 g/l) with possible substrate inhibition at a high concentration (12 g/l). The total biogas production could be correlated to the three factors, using the quadratic equation: Gas =0.17 + 7.11Glu - 0.02Pep + 0.77Yes - 0.53Glu2 + 0.09Glu*Pep. The experimental results showed that the strain could grow well in substrate with high organic nitrogen content such as POME and might be not suitable for substrate with high sugar content due to substrate inhibition.
The objective of this review is to better understand the concept of investigator-initiated trials and its benefits. While investigator-initiated trials can be an invaluable tool, there are several challenges in its initiation and management. However, it is for these reasons that Clinical Research Centre (CRC) had developed the Investigator Initiated Trial (IIT) Programme where financial support and technical assistance are provided to local investigators embarking on their own clinical trials. In the course of preparing the review, we found that the inclination of investigator-initiated trials has yet to be well established in Ministry of Health, Malaysia. Given the potential and impact of such trials, clinicians should be aware of their ability as well as the availability of a supportive network in mobilising their concerted research efforts. Greater research collaboration among investigators could foster more innovative, insightful and constructive research.
Over the last decade, researchers in health services research started using qualitative research methods. This has led to a corresponding rise in the reporting of the qualitative research studies in medical and related journals, including dental journals. Qualitative research is often contrasted with quantitative research as a set of 'non quantitative methods', since it does not deal with numbers and enumerate phenomena. It interprets the information people bring to research, which helps us to understand social phenomena in natural settings like their own territory, in their own language and on their own terms, giving emphasis to the meaning, experience and view of all the participants.
CLINICAL RELEVANCE: This article will help the clinician to understand the importance of in-depth knowledge of behaviour and social phenomena around the patient.
The C3435T, a major allelic variant of the ABCB1 gene, is proposed to play a crucial role in drug-resistance in epilepsy. The C/C genotype carriers reportedly are at higher risk of pharmacoresistance to AEDs, but only in some studies. The hypothesis of the C-variant associated risk and resistance to antiepileptic drugs (AEDs) has been hampered by conflicting results from inadequate power in case-control studies. To assess the role of C3435T polymorphism in drug-resistance in epilepsy, a systematic review and meta-analysis was conducted.
The human small intestine, with its enormous absorptive surface area, is invariably the principal site of drug absorption. Hence, the residence time of a dosage form in this part of the gut can have a great influence on the absorption of the contained drug. Various methods have been employed to monitor the gastrointestinal transit of pharmaceutical dosage forms, but the use of gamma-scintigraphy has superceded all the other methods. However, careful consideration of the time interval for image acquisition and proper analysis of the scintigraphic data are important for obtaining reliable results. Most studies reported the mean small intestinal transit time of various dosage forms to be about 3-4h, being closely similar to that of food and water. The value does not appear to be influenced by their physical state nor the presence of food, but the timing of food intake following administration of the dosage forms can influence the small intestinal transit time. While the mean small intestinal transit time is quite consistent among dosage forms and studies, individual values can vary widely. There are differing opinions regarding the effect of density and size of dosage forms on their small intestinal transit properties. Some common excipients employed in pharmaceutical formulations can affect the small intestinal transit and drug absorption. There is currently a lack of studies regarding the effects of excipients, as well as the timing of food intake on the small intestinal transit of dosage forms and drug absorption.