Displaying publications 161 - 180 of 704 in total

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  1. Fulltext Variation of polypharmacy in older primary care attenders occurs at prescriber level
    Ong SM, Lim YMF, Sivasampu S, Khoo EM
    BMC Geriatr, 2018 02 23;18(1):59.
    PMID: 29471806 DOI: 10.1186/s12877-018-0750-2
    BACKGROUND: Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics.

    METHODS: We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics.

    RESULTS: A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level.

    CONCLUSION: Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.

    Matched MeSH terms: Physicians, Primary Care/standards; Physicians, Primary Care/trends*; Physicians, Primary Care/statistics & numerical data
  2. Fulltext EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process
    Bergin PS, Beghi E, Sadleir LG, Brockington A, Tripathi M, Richardson MP, et al.
    Epilepsia Open, 2017 Mar;2(1):20-31.
    PMID: 29750210 DOI: 10.1002/epi4.12033
    Objective: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials.

    Methods: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification.

    Results: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70.

    Significance: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to participate in these investigator-led clinical trials.
    Matched MeSH terms: Physicians
  3. Fulltext Role of medical education in cultivating lifelong learning skills for future doctors
    Marzo, Roy Rillera
    Education in Medicine Journal, 2018;10(3):63-66.
    MyJurnal
    Medical knowledge, skills, and social requirements for patient care are quickly changing, thus, doctors
    are anticipated to be life-long learners to provide effective care for the patients. This paper addresses
    instructional issues how to prepare medical students to be self-directed learners and how to improve
    medical school and postgraduate training curricula. Now the big question is self-directed learning
    (SDL) an agent in cultivating lifelong learning skills for medical students as claimed by educational
    experts? This will be the focus of my critical reflection on lifelong learning.
    Matched MeSH terms: Physicians
  4. Fulltext Future of family medicine in developing countries
    Rajakumar MK
    10th WONCA World Conference, 1983.
    Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 23-26
    Matched MeSH terms: Physicians
  5. Knowledge of inhaler technique among doctors
    Liam CK
    Family Physician, 1993;5:22-26.
    The knowledge of 16 medical officers and 21 house officers from the Department of Medicine regarding the technique of using the pressurised metered dose inhaler (MDI) was evaluated. The doctors were interviewed individually and each was requested to demonstrate the use of a placebo inhaler. Only 21.6% of the participants correctly performed all the ten steps considered to constitute correct inhalation technique. The most common mistake was failure to actuate the inhaler at the start of breathing in through the mouth. Although inhaler technique was better among the medical officers, all of whom claimed to have instructed patients on the use of pressurised MDIs, house officers who were also involved in patient instruction performed equally well. Unfortunately, doctors with inadequate technique had also instructed patients and this could be one of the causes of incorrect technique among patients. Key words: Correct technique, doctors, pressurised metered dose inhaler
    Matched MeSH terms: Physicians
  6. Fulltext Founding of the College of General Practitioners Malaysia
    Param Palam S
    Family Practitioner, 1973;1(1):9-12.
    Matched MeSH terms: Physicians, Family
  7. Editorial. General practitioners' role in V. D. treatment and health education
    Lau J
    Family Practitioner, 1975;2(3):5-9.
    Matched MeSH terms: Physicians, Family
  8. Why are nasopharyngeal carcinoma patients diagnosed at late stage ?
    Prasad U, Pua KC
    JUMMEC, 1999;4:39-42.
    100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.
    Matched MeSH terms: Physicians
  9. Fulltext Career choices of physicians in Malaysia
    Ahmad Z, Jaafar R
    JUMMEC, 1999;4(1):47-50.
    A survey of career choices was conducted for two batches of physicians applying for a medical speciality course in Malaysian medical schools. There were a total of 952 applications, with 477 males and 475 females. Surgery ranked highest, followed by obstetrics and gynaecology, fanlily medicine and orthopaedic surgery. The minor specialities of otorhinolaryngology, psychiatry and pathology were the least popular choices. Questionnaires were sent to a random sample of 250 physicians in each batch to note factors affecting their choices of speciality. A total of 359 physicians responded, giving a response rate of 71.8%. Fixed hours of work and the ability to have direct contact with patients were relatively important factors for choice of speciality. Working as a clinical consultant was the nlost popular nature of employment while worliing in the health office, service consultant in a public hospital, a non-clinical lecturer in a university hospital and working in a private clinic were less popular choices for these physicians. KEYWORDS: Career choice; medical speciality; doctors; Malaysia.
    Matched MeSH terms: Physicians
  10. Fulltext HoneyDetails: A prototype for ensuring patient's information privacy and thwarting electronic health record threats based on decoys
    Esther Omolara A, Jantan A, Abiodun OI, Arshad H, Dada KV, Emmanuel E
    Health Informatics J, 2020 09;26(3):2083-2104.
    PMID: 31957538 DOI: 10.1177/1460458219894479
    Advancements in electronic health record system allow patients to store and selectively share their medical records as needed with doctors. However, privacy concerns represent one of the major threats facing the electronic health record system. For instance, a cybercriminal may use a brute-force attack to authenticate into a patient's account to steal the patient's personal, medical or genetic details. This threat is amplified given that an individual's genetic content is connected to their family, thus leading to security risks for their family members as well. Several cases of patient's data theft have been reported where cybercriminals authenticated into the patient's account, stole the patient's medical data and assumed the identity of the patients. In some cases, the stolen data were used to access the patient's accounts on other platforms and in other cases, to make fraudulent health insurance claims. Several measures have been suggested to address the security issues in electronic health record systems. Nevertheless, we emphasize that current measures proffer security in the short-term. This work studies the feasibility of using a decoy-based system named HoneyDetails in the security of the electronic health record system. HoneyDetails will serve fictitious medical data to the adversary during his hacking attempt to steal the patient's data. However, the adversary will remain oblivious to the deceit due to the realistic structure of the data. Our findings indicate that the proposed system may serve as a potential measure for safeguarding against patient's information theft.
    Matched MeSH terms: Physicians
  11. Fulltext Artificial intelligence enabled healthcare: A hype, hope or harm
    Bhattacharya S, Pradhan KB, Bashar MA, Tripathi S, Semwal J, Marzo RR, et al.
    J Family Med Prim Care, 2019 Nov;8(11):3461-3464.
    PMID: 31803636 DOI: 10.4103/jfmpc.jfmpc_155_19
    In this paper, we have described the health care problem (maldistribution of doctors) in India. Later, we have introduced the concept of artificial intelligence and we have described this technology with various examples, how it is rapidly changing the health care scenario across the world. We have also described the various advantages of artificial intelligence technology. At the end of the paper, we have raised some serious concerns regarding complete replacement of human based health care technology with artificial intelligence technology. Lastly, we concluded that we have to use artificial intelligent technology to prevent human sufferings/health care problems with proper caution.
    Matched MeSH terms: Physicians
  12. Fulltext The effect of long working hours among medical doctors in northwest Malaysia: the interplay between personality big five inventory and fatigue
    Karniza Khalid, Thyagarajan, Dandaithapani, Muhammad Zul Azri Mohammad Yusof, Ruzita Jamaluddin
    Journal of Occupational Safety and Health, 2019;16(2):1-9.
    MyJurnal
    Medical professionals work in a constantly stressful environment. The nature of the profession requires routine extended working hours, but little is known about the effect of long working hours on selective physiological measures. A cross-sectional feasibility study was conducted from 1 October 2017 until 30 April 2018 on medical doctors in a tertiary health centre in northwest Malaysia. There was a total of 55 study participants recruited. The overall systolic blood pressure (SBP) was highest after working 24-hour stretch (p=0.006) and the overall diastolic blood pressure (DBP) were highest after working for 33 hours in a single stretch, at the end of on call rotation (p
    Matched MeSH terms: Physicians
  13. Fulltext The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific
    Dowrick C, Kassai R, Lam CLK, Lam RW, Manning G, Murphy J, et al.
    J Multidiscip Healthc, 2020;13:1693-1704.
    PMID: 33268991 DOI: 10.2147/JMDH.S271070
    Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including delivery of training programs for healthcare staff and access to resources for patients, is described. Finally, key next steps are proposed to promote enhanced integration into primary care and improve mental health care throughout the APEC region.
    Matched MeSH terms: Physicians, Family
  14. Fulltext Anticipated difficulties in house-officership for graduating medical students of the school of medical sciences, universiti sains malaysia kubang kerian, kelantan, malaysia
    Rahim AF, Hitam WH, Alwi MN, Ghazali G, Rahim SZ
    Malays J Med Sci, 2000 Jul;7(2):9-12.
    PMID: 22977384
    To aid future curriculum revision and planning, a batch of newly graduated medical students were surveyed using a questionnaire containing items representing possible areas of concern during house-officership. Students rated items representing communication issues as areas of concern. They did not agree that areas concerning responsibilities as a doctor, continuing medical education, theoretical and practical skills and potentially stressful working conditions were problem areas. Communication skills should remain among the priority areas for undergraduate training. Students should also be given more information about the house-officership period prior to graduation. Further study is needed to confirm perceived strengths of the USM curriculum suggested by the study, which are skills in finding resources for further learning and skills in leadership. A task-analysis of the house-officership period is also needed.
    Matched MeSH terms: Physicians
  15. 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
  16. 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
  17. The management of attempted suicide--reflections of a physician
    Frank AO
    Med J Malaysia, 1977 Jun;31(4):281-4.
    PMID: 927232
    Matched MeSH terms: Physicians
  18. Fulltext Attitude of patients towards anaesthesia: comparing the use of a single consent for anaesthesia versus the combined surgical and anaesthetic consent
    Niew, Y.L., Chee, Magdalene M.X., Juanita, J., Nurul Ezzati, A.K., Mohd Sharol, A.W., Azarinah, I., et al.
    Journal of Surgical Academia, 2014;4(2):9-13.
    MyJurnal
    Anaesthesiology is a specialty which is less well known and the public usually have little knowledge regarding anaesthesia and the roles of Anaesthesiologist. Many hospitals now use a single dedicated consent for anaesthesia. This study was conducted to compare the effectiveness of a single consent for anaesthesia with the combined surgical and anaesthetic consent. A total of 109 patients, scheduled for elective surgery requiring anaesthesia were interviewed with a standardised questionnaire. Patients were divided into two groups, where one group used a single anaesthetic consent while the other used a combined surgical and anaesthetic consent. A single consent for anaesthesia was found to be more effective than the current combined surgical and anaesthetic consent (p
    Matched MeSH terms: Physicians
  19. Fulltext Effectiveness of 18-hour lactation management course organised by district health office for health staff
    Tan, K.L., Ghani, S.N.
    JUMMEC, 2007;10(1):21-24.
    MyJurnal
    This was a cross-sectional study which attempts to assess the effectiveness of the 18-hour lactation management course organised by Klang District Health Office for its health staff. The course was conducted for three days from 19 to 21 September, 2006 with a total of 18 hours, comprising 15 hours of lectures and three hours of supervised clinical experience. There were a total of 46 participants for the course. The pre- and post-test scores of the participants from the course were used for analysis. This study showed that the mean pre-test versus mean post-test scores were 12.63 and 19.87. The difference in the mean score was statistically significant (p < 0.001, 95%CI -8.285, -6.193). The difference was significant for the staff nurse, community nurse and assistant nurse but not for doctors. In conclusion, the 18-hour duration lactation management course was effective at improving the knowledge and skills on breastfeeding management for the health staff.
    Matched MeSH terms: Physicians
  20. Fulltext Improvement in documentation of intake and output chart
    Ling, W.W., Ling, L.P., Chin, Z.H., Wong, I.T., Wong, A.Y., Nasef, A., et al.
    Int J Public Health Res, 2011;1(2):152-162.
    MyJurnal
    Intake and Output (I/O) records in hospitals were often found to be incomplete and illegible. The form used to record I/O is not user-friendly - i.e., they feature miniscule boxes, 'total' lines that do not correspond with shift changes and lack of instructions. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. Moreover, Nursing Sisters objective rounds often saw incompleteness of I/O chart. This study aims to identify the types of mistakes in recording the existing I/O chart. The second aim is to find out whether shift totalling of I/O chart helps in reducing mistakes. We try to determine whether the identified mistakes were repeated in the new I/O Chart. This study was conducted from October till December 2010 in 9 selected wards in Sibu Hospital. Data collection was divided into 3 phases. A pre-implementation audit using a checklist was carried out. The compliance rate of completeness of documentation of I/O Chart was 63%. A one month trial of new I/O chart was being done in the selected 9 wards. Post implementation audit showed a significant improvement of compliance rate (88%). Feedback from health care workers (N=110) showed that, 89% of doctors (n=17) and 60% of nurses (n=93) in the sample prefer to use the new format as more practical and relevant to the changing shift of nurses and doctors' ward round. It is suggested to implement the new format to increase compliance rate of documentation of I/O charting. Briefing should be given to nurses periodically and the new format should be introduced to nursing students in nursing colleges.
    Matched MeSH terms: Physicians
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