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Fulltext Case series of children with steroid-Induced glaucoma

Lam, C.S., Umi Kalthum, M.N., Norshamsiah, M.D., Bastion, M.L.C.

Malaysian Family Physician, 2018;13(3):32-37.
MyJurnal

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids,
particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent,
and children are commonly being prescribed topical anti-inflammatories, including topical steroids,
by general practitioners. Furthermore, topical steroids are also available over the counter, and this
availability contributes to overuse without proper monitoring by an ophthalmologist. We present
a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids
among children for vernal keratoconjunctivitis. The medications were prescribed initially by general
ophthalmologists and were continually bought over the counter by parents. At the presentation to
our center, these patients were already compromised visually, exhibiting glaucomatous optic disc
changes and high intraocular pressure. The series highlights the optic nerve damage resulting in
irreversible visual compromises among children on long-term, topical steroids and the importance
of regular monitoring with a low threshold for ophthalmologist referral.

Matched MeSH terms: Referral and Consultation
Fulltext Lessons Learned: Patient Communication During the Pandemic

Wang E, Real I, David-Wang A, Rubio DA, Gaston CL, Quintos AJ, et al.

Malays Orthop J, 2021 Mar;15(1):12-15.
PMID: 33880142 DOI: 10.5704/MOJ.2103.002

A series of mortalities among musculoskeletal tumour patients secondary to medical illnesses during the first few months of the pandemic highlighted the need to review our methods of communication with patients. Prominent among patients' concerns had been a fear of consulting at hospitals and a lack of ready access to health care. Recommendations are made for proactive consultation and patient education, identifying at-risk patients for follow-up and probing for possible co-morbidities. Telemedicine use is encouraged bearing in mind its inherent limitations. A network of physicians and pharmaceutical representatives is an added help we can offer our patients who may be isolated by community quarantine.

Matched MeSH terms: Referral and Consultation
Fulltext Clinico-pathological study of malignant odontogenic tumours from a national referral centre

Sathasivam HP, Saw CL, Lau SH

BMC Oral Health, 2021 03 18;21(1):129.
PMID: 33736630 DOI: 10.1186/s12903-020-01365-3

BACKGROUND: Malignant odontogenic tumours are extremely rare tumours occurring within the jaws. Our study was performed to determine the demographic and clinico-pathological features of malignant odontogenic tumours amongst a multi-ethnic Asian population.
METHODS: This was a retrospective cross-sectional study of malignant odontogenic tumours diagnosed at the Institute for Medical Research, Malaysia, from 2009 to 2019. All cases were independently reviewed and reclassified following the criteria set out in the latest edition of the World Health Organization 2017 reference text. Demographic and clinico-pathological data were recorded for each case.
RESULTS: Twenty-four cases of malignant odontogenic tumours were identified. The patients' age ranged from 16 to 79 years with the mean age at diagnosis being 50.8 years (SD = 16.18). There was a male predominance (66.7%) in this cohort of patients. The ethnic distribution appeared to reflect the Malaysian population with most cases seen amongst the Malay ethnic group (66.7%). Ameloblastic carcinoma was the most frequently diagnosed malignant odontogenic tumour (45.8%) and was also predominantly seen in males (90.9%). All patients with clear cell odontogenic carcinoma were females. There was no obvious sex predilection in primary odontogenic carcinoma not otherwise specified (NOS). The mandible (79.2%) was more frequently involved compared to the maxilla.
CONCLUSIONS: Diagnosis and management of malignant odontogenic tumours are challenging due to the rarity of these tumours. Our study has elucidated the clinico-pathological features of malignant odontogenic tumours seen in a multi-ethnic Asian population.

Matched MeSH terms: Referral and Consultation
Fulltext Practising shared decision making in primary care

Ng CJ, Lee PY

Malays Fam Physician, 2021 Mar 25;16(1):2-7.
PMID: 33948136 DOI: 10.51866/cm0001

Making healthcare decisions collaboratively between patients and doctors can be challenging in primary care, as clinical encounters are often short. Conflicts between patients and doctors during the decision-making process may affect both patient and doctor satisfaction and result in medico-legal consequences. With the increasing recognition of the importance of patient empowerment, shared decision making (SDM) can serve as a practical consultation model for primary care doctors (PCDs) to guide patients in making informed healthcare choices. Although more research is needed to find effective ways to implement SDM in the real world, the 6-step approach presented in this paper can guide PCDs to practise SDM in their daily practice. Implementation of SDM can be further enhanced by incorporating SDM training into undergraduate and postgraduate curricula and using evidence-based tools such as patient decision aids.

Matched MeSH terms: Referral and Consultation
Fulltext The effectiveness of a Malaysian House Officer (HO) preparatory course for medical graduates on self-perceived confidence and readiness: A quasi-experimental study

Rashid AA, Ghazali SS, Mohamad I, Mawardi M, Musa H, Roslan D

PLoS One, 2020;15(7):e0235685.
PMID: 32678838 DOI: 10.1371/journal.pone.0235685

INTRODUCTION: House Officer (HO) Preparatory Courses in Malaysia are designed to prepare medical graduates to work as a HO. The courses are designed to address the issues related to lack of confidence and readiness to work, which could lead to stress and HO dropping out of work. The modules focus on how to prepare medical graduates into the real-life working scenario. Hence, we determined the effectiveness of a HO Preparatory Course on the level of confidence and readiness to work among medical graduates.
METHODOLOGY: A quasi-experimental study was conducted at three time-points (pre-intervention, post-intervention and one-month after working as a HO) on the level of confidence and readiness of medical graduates. The intervention was the Medicorp module, which included information and training needed for the HO such as common clinical cases in the wards, case referrals, experience sharing and hands on clinical training. We recruited eligible participants undergoing the course between April-November 2018. The adapted IMU Student Competency Survey was used to measure the confidence and readiness levels, which were scored from a Likert scale of 1-5. The higher score indicated higher levels of confidence or readiness.
RESULTS: A total of 239 participants were recruited at baseline (90% response rate). They were mostly female (77.8%), Malays (79.1%), single (90.0%), graduated overseas (73.6%), in 2018 (65.3%). The mean (SE) confidence scores significantly increased from 2.18 (1.00) pre-course to 3.50 (0.75) immediately after course and 3.79 (0.92) after one-month of work (p <0.001, η2 = 0.710). The mean (SE) readiness scores at pre-course, immediately and one-month post work were 2.36 (1.03), 3.46(0.78) and 3.70(0.90), respectively (p< 0.001, η2 = 0.612).
CONCLUSION: The HO Preparatory Course module was effective in increasing levels of confidence and readiness for medical graduates, most of whom are overseas graduates; namely Egypt, Russia and Indonesia.

Matched MeSH terms: Referral and Consultation
An infant with kwashiorkor: The forgotten disease

Kamaruzaman NA, Jamani NA, Said AH

Malays Fam Physician, 2020;15(2):46-49.
PMID: 32843945

Undernutrition remains a major public health concern, especially in developing countries. Despite being rich in resources, Malaysia is still home to children suffering from severe undernutrition. This paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper weaning which was overlooked. This case highlights the importance of recognizing the early signs of kwashiorkor to allow for early referrals for proper management and prevent its possible complications.

Matched MeSH terms: Referral and Consultation
Fulltext Analysis on Entrepreneurship Psychology of Preschool Education Students With Entrepreneurial Intention

Yin Y, Yang L, Liu B

Front Psychol, 2020;11:1559.
PMID: 32733339 DOI: 10.3389/fpsyg.2020.01559

To diversify the creative thinking of preschool education students and improve their ability to innovate and start a business, a survey of preschool education students under entrepreneurial psychology theory was conducted in this research. Based on the theoretical foundation of entrepreneurial psychology, this article analyzed the entrepreneurial psychological quality and psychological education of college students. By investigating preschool education students in a certain college in Sichuan as the research object, the author explored the current entrepreneurial intentions of college students and their entrepreneurial psychological problems. In response to the current entrepreneurial situation of college graduates, relevant countermeasures were proposed from the perspective of the school to support their entrepreneurial psychology. Among the 205 preschool education college students, the students were more willing to give full play to their professional expertise in terms of employment intentions. At the same time, there were still situations in which students were dissatisfied with the prospects of preschool education career development and wanted to achieve the value of life through other approaches. Most students in preschool education had a wait-and-see attitude toward entrepreneurship. Only 35% of students had a clear intention to start a business and made their plans for entrepreneurship. More than 90% of students held that they had developed inadequate entrepreneurial ability, and 80% of students believed that they lacked the required professional knowledge. These two factors constitute the main reasons for students' negative attitudes toward entrepreneurship. Nevertheless, colleges may stimulate the potential of students' self-development through the improvement of entrepreneurial psychological education courses, the construction of psychological consultation institutions on campus, and the establishment of interactive platforms for entrepreneurship. In this way, students' entrepreneurial psychology can be cultivated in an all-round way. Therefore, to deal with the weak overall entrepreneurial consciousness of college students, the colleges should cultivate entrepreneurial innovative talents by strengthening the psychological education of entrepreneurship for students, and help college students achieve entrepreneurial success.

Matched MeSH terms: Referral and Consultation
Fulltext Use of Adjuvant Endocrine Therapy Among Post-Menopausal Breast Cancer Patients in Malaysia

Saiful Bahri A, Tuan Mahmood TM, Abdul-Aziz SA, Makmor-Bakry M, Mohamed Shah N

Patient Prefer Adherence, 2021;15:227-235.
PMID: 33568899 DOI: 10.2147/PPA.S293029

Context: Globally, breast cancer is the most common cancer affecting women, and adjuvant endocrine therapy (AET) is part of its treatment modality, which improves patients' outcome. However, there are concerns on side effects related to its use, which may affect treatment adherence.
Purpose: This study was conducted to explore attitude and practice on using AET among breast cancer patients in Malaysia.
Patients and Methods: Postmenopausal breast cancer patients on at least 3 months of AET attending the outpatient oncology clinic at a tertiary care hospital were interviewed. Patients underwent in-depth interviews exploring their attitude and practices while on AET using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using thematic analysis.
Results: There were four main themes for attitude toward the use of AET: 1) benefits of using AET, 2) concerns on taking AET, 3) beliefs on alternative treatment, and 4) beliefs toward the doctor. For practice, six themes were obtained: 1) correct use of AET, 2) appointment adherence, 3) information-seeking behavior, 4) counseling services obtained, 5) experienced side effects of AET, and 6) usage of complementary and alternative medicines.
Conclusion: Several themes concerning attitude and practice of breast cancer patients receiving AET were identified, which may be addressed during treatment consultations in clinical practice.

Matched MeSH terms: Referral and Consultation
Fulltext Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

Liew SK, Shim BJ, Gong HS

Korean J Neurotrauma, 2020 Oct;16(2):126-137.
PMID: 33163420 DOI: 10.13004/kjnt.2020.16.e48

Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.

Matched MeSH terms: Referral and Consultation
Fulltext A pilot design of a protocol for a university-wide community- based occupational health screening project: HUMS2U

Nicholas Pang, Sofeinah Didora Judip, Jeanny John, Erwani Minin, Noor Rajrinnie Rajak, Luqman Ridha Anwar, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):63-0.
MyJurnal

Introduction: University-wide healthcare programme are difficult to implement without complete protocols. This paper describes a collaborative academia-nursing programme to design a quick, user-friendly primary care screen- ing toolkit, to be used at community level at each faculty in UMS. Methods: A Primary Care Condition Assessment Questionnaire was designed by family medicine physicians, mental health doctors, and public health physicians. The questionnaire was pilot tested in 2 different faculties. The Primary Care Condition Assessment Questionnaire was manualized, and a one-day intervention training programme was administered. Subsequently 19 nurses and assistant medical officers were trained in the questionnaire administration and given concurrent communication skills and collaborative practice training to operate the questionnaire. Qualitative assessments of abilities to perform common primary health assessments were performed. Results: Trained nurses qualitatively felt they were more con- fident to perform primary care screening of common healthcare conditions and were able to deliver advice and refer screen-positive individuals to appropriate referral pathways. Conclusion: Public health programmes like HUMS2U put healthcare into the hands of nurses, allowing task-shifting to adequately trained non-specialist professions, and empowers nurses in basic non-communicable disease training and management. Further research will be performed to assess efficacy of the programme at all 23 faculties and departments of the university.

Matched MeSH terms: Referral and Consultation
Profile of a low vision clinic population

Mohidin N, Yusoff S

Clin Exp Optom, 2002 12 17;81(5):198-202.
PMID: 12482319

BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.

Matched MeSH terms: Referral and Consultation
Fulltext A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal

Rajbanshi S, Norhayati MN, Nik Hazlina NH

Int J Environ Res Public Health, 2021 05 28;18(11).
PMID: 34071394 DOI: 10.3390/ijerph18115801

Maternal and neonatal morbidity and mortality tend to decrease if referral advice during pregnancy is utilized appropriately. This study explores the reasons for nonadherence to referral advice among high-risk pregnant women. A qualitative study was conducted in Morang District, Nepal. A phenomenological inquiry was used. Fourteen participants were interviewed in-depth. High-risk women who did not comply with the referral to have a hospital birth were the study participants. Participants were chosen purposively until data saturation was achieved. The data were generated using thematic analysis. Preference of homebirth, women's diminished autonomy and financial dependence, conditional factors, and sociocultural factors were the four major themes that hindered hospital births. Women used antenatal check-ups to reaffirm normalcy in their current pregnancies to practice homebirth. For newly-wed young women, information barriers such as not knowing where to seek healthcare existed. The poorest segments and marginalized women did not adhere to referral hospital birth advice even when present with high-risk factors in pregnancy. Multiple factors, including socioeconomic and sociocultural factors, affect women's decision to give birth in the referral hospital. Targeted interventions for underprivileged communities and policies to increase facility-based birth rates are recommended.

Matched MeSH terms: Referral and Consultation
Fulltext Retrospective descriptive study of patients with dermatological problems, at UMS Polyclinic, Kingfisher, Kota Kinabalu, Sabah. [Abstract]

Khaing MS, Parash MTH, Shimmi SC, Kabir S, Chodanakar NC, Subramaniam P, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):89-89.
MyJurnal

ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 3rd-5th September 2019
Introduction: Since January 2010, the UMS Polyclinic, situated at Riverside Plaza, Kingfisher Park, Kota Kinabalu, Sabah, provided general medical consultation as well as specialist consultations comprising of Internal Medicine, Endocrinology (Diabetes and related problems), Dermatology, Rheumatology, Cardiology including ECG and ECHO services, Orthopedic, Ophthalmology, ENT (Ear, Nose and Throat), Obstetrics and Gynecology, Pediatrics and Psychiatry. The purpose of this study was to look into the Dermatology consultations provided by the UMS Polyclinic in order to improve health care services, by reporting on the demographic characteristics of the patients with reference to the provisional diagnosis and management offered, as well as referrals to tertiary health care centers for further managements. Methods: It was a retrospective, descriptive study which included 76 patients who visited the Dermatology Specialist Clinic at UMS Polyclinic from January to December 2018.
Results: The 76 patients comprised of 50 males and 26 female patients with the age ranged from 2 years to 86 years, with 5 children (under the age of 12 years).The catchment population of the patients were mainly from Universiti Malaysia Sabah, Kingfisher, and also from wide areas of Kota Kinabalu with a few from Kudat,Tamparuli, Telipok, Keningau, Kinarut and Beaufort, etc. The consultations comprised of 19 varieties of dermatological problems to which were given appropraite management. The period of the year 2018 under study showed highest attendance in February with 21 patients (27.6%) followed by 13 patients (17.1%) in October with December showing 11 patients (14.5% ).
Conclusion: A total of 32 varieties of Dermatological problems were found among the 76 patients consulted. Acne Vulgaris was found to be the highest variant with 12 cases(15.7%) with Seborrhoeic Dermatitis seen as 5 cases (6.5%) followed by 4 cases (5.2%) each of Contact Dermatitis, Allergy/Hypersensitivity, Photosensitive Dermatitis, and Vitiligo. Certain patients had to be referred to Dermatology Department at Hospital Queen Elizabeth for further management, like for skin biopsy, and also for Electro-cautery machine, Phototherapy, and Laser, as we are still waiting for few equipments.

Matched MeSH terms: Referral and Consultation
Fulltext Nutritional status and the use of protease inhibitors among Hiv-infected children in Klang Valley, Malaysia

Mohd. Nasir, M. T., Yeo, J., Huang, M. S. L., Koh, M. T., Kamarul Azhar, R., Khor, G. L.

Malaysian Journal of Medicine and Health Sciences, 2011;7(2):73-79.
MyJurnal

This study determined the association between nutritional status and the use of protease inhibitors (PI)
containing regimen among HIV-infected children receiving treatment at the referral centres in Klang
Valley. A total of 95 children currently on antiretroviral (ARV) therapy, aged one to eighteen years, were recruited using purposive sampling. Demographic data, anthropometric measurements, medical history, were collected using a structured questionnaire. Serum micronutrients levels and lipid profile were also examined using blood samples. Mean age was 8.8 3.9 years and 44.2% were on PI. Age ( 2 = 10.351, p = .006), weight-for-age ( 2 = 6.567, p = .010), serum selenium ( 2 = 4.225, p = .040) and HDL-C ( 2 = 7.539, p = .006) were significantly associated with the use of PI. Fewer children on PI were deficient in selenium as compared to those not on PI. On the contrary, more children on PI were underweight and had low HDL-C. The use of PI was found to have both positive and negative effects with better selenium level but poorer HDL-C level and weight status.

Matched MeSH terms: Referral and Consultation
Fulltext Patterns and predictors of smoking cessation among smokers attending Smoking Cessation Clinics in Peninsular Malaysia

Wan Puteh SE, Selahuddeen AA, Aljunid SM, Zarihah Z

Malaysian Journal of Community Health, 2008;14(1):17-23.
MyJurnal

Introduction: This study seeks to identify the socio-demographic and behavioral characteristics of smokers (aged 18 and above), thus develop a predicting model for tobacco abstinence receiving cessation services for tobacco dependence at the Smoking Cessation Clinics (SCC) in government Primary Health Centers in Malaysia. These predictors would improve the effectiveness and efficiency of these clinics.
Methods : Smokers who sought smoking cessation therapy at the SCCs from 1st January 2004 to 31st
December 2004 were chosen randomly from clinic’s registries, and 254 smokers were recruited from 8 clinics chosen through stratified random sampling. Data analyses were performed with SPSS 12.0. 17.3% of smokers attending SCCs were able to quit smoking for at least six months.
Results : Factors significantly contributing to quitting success were elderly smokers (above 40 years old), smoked for more than 15 years, smoked less than ten sticks per day, had a previous history of quitting attempt, self referral to the clinic, high confidence level, attended SCC at least four times, each counseling session lasted for at least 30 minutes and were satisfied with the clinic service. In logistic regression model, smokers aged 40 years and above were 6.7 times more successful to quit, high level of confidence were nine times more successful, smoked more than ten sticks per day were ten times less successful, self referred smokers were ten times more successful and attending for at least 30 minutes counseling session were 12 times more successful.
Conclusion : This study concludes that more concerted effort is needed to approach various groups of target population and SCCs clinic services need to be improved.

Matched MeSH terms: Referral and Consultation
Fulltext Haematinics for anaemia in the elderly

Khoo SB

Malays Fam Physician, 2011;6(1):7-14.
MyJurnal

Anaemia is the most common haematological problem in the elderly population. Using WHO criteria for anaemia (Hb of <12 g/dL in women and <13 g/dL in men), the prevalence of anaemia in the elderly has been found to range from 8-44% with the highest prevalence in men 85 years and older. Anaemia must not be considered simply as part of ageing because in 80% of cases, there is an underlying cause for Hb
levels of <12 g/dL in the elderly. Anaemia has negative impacts on the quality of life for the elderly and there is evidence of improved morbidity and
mortality after correction of anaemia. Chronic disease and thalassaemia may also cause microcytic anaemia besides iron deficiency and not all vitamin B12 and folate deficiency present with macrocytic megaloblastic anaemia. Nutritional deficiency anaemias are common, easily diagnosed, treatments are simple, inexpensive and effective. Tests for nutritional anaemia have to be given priority in the assessment before a patient is subjected to invasive tests to look for less common causes of anaemia. Serum ferritin which is the best non-invasive test for the diagnosis of iron deficiency anaemia may be increased in the elderly while serum iron and transferrin decrease with ageing. Serum methylmalonic acid (MMA) and homocysteine (HC) levels are sensitive for detecting subclinical vitamin B12 and folate deficiency. Routine iron therapy in non-anaemic elderly or in those without iron deficiency anaemia is of no use and may be detrimental to their health. Folate therapy may improve anaemia but may mask the signs and symptoms of neurological damage due to concomitant
vitamin B12 deficiency. Blood transfusion offers prompt symptom relief of anaemia in patients with terminal malignancy irrespective of the causes for the anaemia.

Matched MeSH terms: Referral and Consultation
Fulltext Mental health: special needs and education

Peters, Huberta

ASEAN Journal of Psychiatry, 2010;11(1):96-102.
MyJurnal

Objective: This review paper will be discussing on mental health of children and adolescents in Malaysia. Behavioural problems, academic failure and underachievement in school are common reasons for referral of children to the medical services. Epidemiological research has substantiated a possible seriously mismatch between the rates of child mental health problems across a broad spectrum and the number of children actually referred to existing services. These data suggest it is imperative in Malaysia to empirically investigate the present realities in the schools in regard to special education needs and their neglect. Methods: The present preliminary study is based on a literature review of epidemiological features of learning disorders and comorbidities using the Cochran library key word search. Available statistics for learning disorders from the WHO are compared with records for the
year 2007 from the Ministry of Education in Malaysia. Results: Findings of this comparison with international prevalence rates of learning disorders and related diseases show a sizable gap between real existing needs in Malaysia, and their perception. Based on quantitative estimates, the findings suggest that some 1.4 million children in Malaysia have mental health difficulties that interfere with normal functioning and development, but adequate services for intervention are largely not available. Conclusion: The present undersupply of adequate service for children with learning difficulties is aggravated by the lack of systematic developmental screening in early childhood in Malaysia. This status affects the outcomes and development of the general education system in efforts to meet challenges in the new century.

Matched MeSH terms: Referral and Consultation
Fulltext Traditional healers are causing treatment delay among patients with psychosis in Hospital Kuala Lumpur: fact or fallacy?

Marhani Midin, Salina Abdul Aziz, Phang, Cheng-Kar

ASEAN Journal of Psychiatry, 2010;11(2):206-215.
MyJurnal

Objective: Mental health services in Malaysia often face competition from traditional healers especially among patients with psychosis. The objective of the study is to determine whether patients who sought help earlier from traditional healers had longer duration of untreated psychosis (DUP), and more adverse experiences in pathways to psychiatric care. Methods: This is a hospital-based cross-sectional study of 50 inpatients with first-episode
psychosis in Hospital Kuala Lumpur. Structured Clinical Interview for DSM-IV (Diagnostic and statistical manual, 4th edition) Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Onset of psychosis was defined as any one positive symptom with a score of >3 on the Positive and Negative Syndrome Scale (PANSS). Socio-demographic
data, information on pathways and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaire. Results: Fifty-four percent of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact
(48%). Contact with traditional healers was not associated with age, gender, ethnic, education level, longer DUP or treatment delay, and admissions with violent behaviour or police assistance. Of those who had sought help from traditional healers, one third were recommended by at least one of their traditional healers to seek medical help. Conclusion:
Consultation involving traditional healers was a popular choice, and not associated with treatment delay. Traditional healers in an urban setting may be potential collaborators in managing patients with first-episode psychosis. Future research should explore the frontiers of such collaborative work.

Matched MeSH terms: Referral and Consultation
Fulltext A feasibility study: Use of actigraph to monitor and follow-up sleep/wake patterns in individuals attending community pharmacy with sleeping disorders

Noor ZM, Smith AJ, Smith SS, Nissen LM

J Pharm Bioallied Sci, 2016 Jul-Sep;8(3):173-80.
PMID: 27413344 DOI: 10.4103/0975-7406.171739

INTRODUCTION: Community pharmacists are in a suitable position to give advice and provide appropriate services related to sleep disorders to individuals who are unable to easily access sleep clinics. An intervention with proper objective measure can be used by the pharmacist to assist in consultation.
OBJECTIVES: The study objectives are to evaluate: (1) The effectiveness of a community pharmacy-based intervention in managing sleep disorders and (2) the role of actigraph as an objective measure to monitor and follow-up individuals with sleeping disorders.
METHODS AND INSTRUMENTS: The intervention care group (ICG) completed questionnaires to assess sleep scale scores (Epworth Sleepiness Scale [ESS] and Insomnia Severity Index [ISI]), wore a wrist actigraph, and completed a sleep diary. Sleep parameters (sleep efficiency in percentage [SE%], total sleep time, sleep onset latency, and number of nocturnal awakenings) from actigraphy sleep report were used for consultation and to validate sleep diary. The usual care group (UCG) completed similar questionnaires but received standard care.
RESULTS: Pre- and post-mean scores for sleep scales and sleep parameters were compared between and within groups. A significant difference was observed when comparing pre- and post-mean scores for ISI in the ICG, but not for ESS. For SE%, an increase was found in the number of subjects rated as "good sleepers" at post-assessment in the ICG.
CONCLUSIONS: ISI scores offer insights into the development of a community pharmacy-based intervention for sleeping disorders, particularly in those with symptoms of insomnia. It also demonstrates that actigraph could provide objective sleep/wake data to assist community pharmacists during the consultation.
KEYWORDS:
Actigraph; community pharmacy; intervention; pharmacist; sleeping disorders

Matched MeSH terms: Referral and Consultation
Fulltext Chronic heel pain: It could be tuberculosis

Muhamad Effendi F, Ibrahim MI, Rozali KN, Miswan MF

Malays Fam Physician, 2016;11(2-3):20-23.
PMID: 28461854 MyJurnal

INTRODUCTION: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.

METHODS: A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis.

RESULT: The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up.

CONCLUSION: Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.

Matched MeSH terms: Referral and Consultation

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