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Fan C, Jiang Z, Teng C, Song X, Li L, Shen W, Jiang Q, Huang D, Lv Y, Du L, Wang G, Hu Y, Man S, Zhang Z, Gao N, Wang F, Shi T, Xin T. Efficacy and safety of intrathecal pemetrexed for TKI-failed leptomeningeal metastases from EGFR+ NSCLC: an expanded, single-arm, phase II clinical trial. ESMO Open 2024; 9:102384. [PMID: 38377785 PMCID: PMC11076967 DOI: 10.1016/j.esmoop.2024.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of intrathecal pemetrexed (IP) for treating patients with leptomeningeal metastases (LM) from non-small-cell lung cancer (NSCLC) who progressed from epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment in an expanded, prospective, single-arm, phase II clinical study (ChiCTR1800016615). PATIENTS AND METHODS Patients with confirmed NSCLC-LM who progressed from TKI received IP (50 mg, day 1/day 5 for 1 week, then every 3 weeks for four cycles, and then once monthly) until disease progression or intolerance. Objectives were to assess overall survival (OS), response rate, and safety. Measurable lesions were assessed by investigator according to RECIST version 1.1. LM were assessed according to the Response Assessment in Neuro-Oncology (RANO) criteria. RESULTS The study included 132 patients; 68% were female and median age was 52 years (31-74 years). The median OS was 12 months (95% confidence interval 10.4-13.6 months), RANO-assessed response rate was 80.3% (106/132), and the most common adverse event was myelosuppression (n = 42; 31.8%), which reversed after symptomatic treatment. The results of subgroup analysis showed that absence of brain parenchymal metastasis, good Eastern Cooperative Oncology Group score, good response to IP treatment, negative cytology after treatment, and patients without neck/back pain/difficult defecation had longer survival. Gender, age, previous intrathecal methotrexate/cytarabine, and whole-brain radiotherapy had no significant influence on OS. CONCLUSIONS This study further showed that IP is an effective and safe treatment method for the EGFR-TKI-failed NSCLC-LM, and should be recommended for these patients in clinical practice and guidelines.
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Affiliation(s)
- C Fan
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Z Jiang
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - C Teng
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - X Song
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - L Li
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - W Shen
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Q Jiang
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - D Huang
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Y Lv
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - L Du
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - G Wang
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Y Hu
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - S Man
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Z Zhang
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin
| | - N Gao
- Department of Oncology, Heilongjiang Sengong General Hospital, Harbin, People's Republic of China
| | - F Wang
- Department of Oncology, Heilongjiang Sengong General Hospital, Harbin, People's Republic of China
| | - T Shi
- Department of Oncology, Heilongjiang Sengong General Hospital, Harbin, People's Republic of China
| | - T Xin
- Department of Oncology, Second Affiliated Hospital of Harbin Medical University, Harbin.
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Liu HL, Bao HG, Zheng CL, Teng C, Bai MH. MiR-130a regulating the biological function of colon cancer by targeting inhibition of PTEN. Eur Rev Med Pharmacol Sci 2021; 24:1786-1793. [PMID: 32141547 DOI: 10.26355/eurrev_202002_20356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the expression of miR-130a in human colon cancer patients and its specific mechanism of regulating the biological function of colon cancer cells. PATIENTS AND METHODS Cancer tissues, paracancerous tissues, and serum samples of 40 colon cancer patients who underwent surgery in The Second Affiliated Hospital of Qiqihar Medical University from May 2018 to March 2019 were collected, and 40 healthy volunteers who received physical examination in The Second Affiliated Hospital of Qiqihar Medical University were collected. Real Time-quantitative Polymerase Chain Reaction (qRT-PCR) was used to detect the expression of miR-130a. Human colon cancer cell was divided into miR-130a mimic group, miR-130a inhibitor group, mimic NC (negative control), and inhibitor NC group. QRT-PCR was used to detect the expression of miR-130a, and MTT assay, colony formation assay, cell scratch assay, transwell assay were performed to detect cell viability, proliferation, migration, and invasion ability. RESULTS Compared with adjacent tissues, the expression of miR-130a was significantly increased in colon cancer tissues (p=0.0125); the expression of miR-130a in transfected miR-130a mimic group was higher than that in NC group, but the expression in transfected miR-130a inhibitor group was significantly lower than that in NC group; overexpression of miR-130a significantly increased cell viability, proliferation, migration, and invasion of colon cancer cells, while knockdown of miR-130a significantly inhibited colon cancer cell biological activity; target prediction, qRT-PCR, and Western blot assays showed that miR-130a participated in the development and progression of colon cancer by targeting inhibition of PTEN expression. CONCLUSIONS The expression of miR-130a in serum and cancer tissues of colon cancer patients is significantly increased, and it can regulate the biological function of colon cancer cells by inhibiting the expression of target gene PTEN. Knockdown of miR-130a may be used as a new clinical treatment for colon cancer.
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Affiliation(s)
- H-L Liu
- Surgical Oncology, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, P.R. China.
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Nagandla K, Gupta ED, Motilal T, Teng CL, Gangadaran S. Performance of medical students in final professional examination: Can in-course continuous assessments predict students at risk? Natl Med J India 2019; 31:293-295. [PMID: 31267998 DOI: 10.4103/0970-258x.261197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Assessment drives students' learning. It measures the level of students' understanding. We aimed to determine whether performance in continuous assessment can predict failure in the final professional examination results. Methods We retrieved the in-course continuous assessment (ICA) and final professional examination results of 3 cohorts of medical students (n = 245) from the examination unit of the International Medical University, Seremban, Malaysia. The ICA was 3 sets of composite marks derived from course works, which includes summative theory paper with short answer questions and 1 of the best answers. The clinical examination includes end-of-posting practical examination. These examinations are conducted every 6 months in semesters 6, 7 and 8; they are graded as pass/fail for each student. The final professional examination including modified essay questions (MEQs), 1 8-question objective structured practical examination (OSPE) and a 16-station objective structured clinical examination (OSCE), were graded as pass/fail. Failure in the continuous assessment that can predict failure in each component of the final professional examination was tested using chi-square test and presented as odds ratio (OR) with 95% confidence interval (CI). Results Failure in ICA in semesters 6-8 strongly predicts failure in MEQs, OSPE and OSCE of the final professional examination with OR of 3.8-14.3 (all analyses p< 0.001) and OR of 2.4-6.9 (p<0.05). However, the correlation was stronger with MEQs and OSPE compared to OSCE. Conclusion ICA with theory and clinical examination had a direct relationship with students' performance in the final examination and is a useful assessment tool.
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Affiliation(s)
- K Nagandla
- Department of Obstetrics and Gynaecology, International Medical University, Seremban, Malaysia
| | - E Das Gupta
- Department of Internal Medicine, International Medical University, Seremban, Malaysia
| | - T Motilal
- Department of Paediatrics, International Medical University, Seremban, Malaysia
| | - C L Teng
- Department of Family Medicine, International Medical University, Seremban, Malaysia
| | - S Gangadaran
- Examination Division, International Medical University, Seremban, Malaysia
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Szostak J, Wong E, Titz B, Martin F, Paneni F, Buettner A, Lee T, Teng C, Lee M, Zhang J, Leroy P, Phillips B, Ivanov N, Peitsch M, Vanscheeuwijck P, Hoeng J. CARDIORESPIRATORY IMPACT OF E-VAPOR AEROSOLS AND CIGARETTE SMOKE EXPOSURE IN THE APOE KNOCKOUT MOUSE MODEL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Eichstadt S, Barriga M, Teng C, Nguyen N, Gorell E, Siprashvili Z, Loutit K, Dutt-Singkh Y, Nazaroff J, Marinkovich M, Tang J. 370 Genetically corrected autologous keratinocyte epidermal grafts improve wound healing and patient reported outcomes in patients with recessive dystrophic epidermolysis bullosa. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Teng C, Lekwuttikarn R, Tafoya E, Martin M, Bruckner A, Mancini A, Stell L, Lu Y, Teng J. 388 A multicenter study on the use of Sildenafil for lymphatic malformation in children. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Son WD, Teng CL. Do statins adversely affect the HbA 1c of diabetic patients? Malays Fam Physician 2017; 12:39-40. [PMID: 28503276 PMCID: PMC5420325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper discusses the adverse effect of statins on the HbA1c levels of diabetic patients. Studies have shown that statins may slightly worsen the HbA1c level. The effects vary depending on the type of statins, the dosage and the duration of therapy. However, it has been confirmed that statin use has benefits that outweigh its harms. Therefore, a diabetic patient should be given advice on the need for appropriate lifestyle changes and the importance of continuing the statins.
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Affiliation(s)
- W D Son
- BSc (Biomed), MBBS International Medical University (Clinical School Seremban) Malaysia. E-mail:
| | - C L Teng
- MMed (FamMed), FAFPM, FRACGP, AM International Medical University (Clinical School Seremban) Malaysia
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Wong CH, Phuah ACL, Naik NSY, Choo WS, Ting HSY, Kuan SML, Teng CL, Sivalingam N. Views of faculty members in a medical school with regards to error disclosure and reporting to parents and/or higher authorities. Med J Malaysia 2016; 71:244-249. [PMID: 28064289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Little is known about the views of faculty members who train medical students concerning open disclosure. OBJECTIVES The objectives of this study were to determine the views of faculty in a medical school on: 1 what constitutes a medical error and the severity of such an error in relation to medication use or diagnosis; 2 information giving following such an adverse event, based on severity; and 3 acknowledgement of responsibility, remedial action, compensation, disciplinary action, legal action, and reporting to a higher body in relation to such adverse event. METHODS We adapted and contextualized a questionnaire developed from a previous study. The questionnaire had 4 case vignettes that described 1 clear medication error with lifelong disability; 2 possible diagnostic error with lifelong disability; 3 possible diagnostic error without harm; and 4 clear medication error without harm. We invited all faculty members attached to the medical school at the International Medical University to participate in the study. RESULTS Seventy faculty members took part. Faculty members viewed a medical error as having taken place depending on how clearly an error had occurred (94% and 73% versus 53% and 27%). They viewed cases as more severe based on the severity of complications (85% and 46% versus 5% and 10%). With increasing severity, they tended to attribute responsibility for the event and the duty to disclose towards more senior clinicians. They were also more agreeable with remedial action, compensation, disciplinary action, and reporting to a higher agency. There was no strong evidence of association between these areas and the demographics of faculty members. CONCLUSIONS Faculty members are more likely to perceive an error had occurred depending on the clarity of the circumstances. They viewed severity based on the presence of complications. Severity determined how they attributed responsibility, duty to disclose, and other areas related to open disclosure.
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Affiliation(s)
- C H Wong
- International Medical University, IMU Clinical School, Department of Family Medicine, Jalan Rasah, Negeri Sembilan, Malaysia.
| | - A C L Phuah
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - N S Y Naik
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - W S Choo
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - H S Y Ting
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - S M L Kuan
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - C L Teng
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
| | - N Sivalingam
- International Medical University, IMU Clinical School, Jalan Rasah, Negeri Sembilan, Malaysia
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Blair KS, Otero M, Teng C, Geraci M, Lewis E, Hollon N, Blair RJR, Ernst M, Grillon C, Pine DS. Learning from other people's fear: amygdala-based social reference learning in social anxiety disorder. Psychol Med 2016; 46:2943-2953. [PMID: 27476529 PMCID: PMC5063696 DOI: 10.1017/s0033291716001537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Social anxiety disorder involves fear of social objects or situations. Social referencing may play an important role in the acquisition of this fear and could be a key determinant in future biomarkers and treatment pathways. However, the neural underpinnings mediating such learning in social anxiety are unknown. Using event-related functional magnetic resonance imaging, we examined social reference learning in social anxiety disorder. Specifically, would patients with the disorder show increased amygdala activity during social reference learning, and further, following social reference learning, show particularly increased response to objects associated with other people's negative reactions? METHOD A total of 32 unmedicated patients with social anxiety disorder and 22 age-, intelligence quotient- and gender-matched healthy individuals responded to objects that had become associated with others' fearful, angry, happy or neutral reactions. RESULTS During the social reference learning phase, a significant group × social context interaction revealed that, relative to the comparison group, the social anxiety group showed a significantly greater response in the amygdala, as well as rostral, dorsomedial and lateral frontal and parietal cortices during the social, relative to non-social, referencing trials. In addition, during the object test phase, relative to the comparison group, the social anxiety group showed increased bilateral amygdala activation to objects associated with others' fearful reactions, and a trend towards decreased amygdala activation to objects associated with others' happy and neutral reactions. CONCLUSIONS These results suggest perturbed observational learning in social anxiety disorder. In addition, they further implicate the amygdala and dorsomedial prefrontal cortex in the disorder, and underscore their importance in future biomarker developments.
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Affiliation(s)
- K. S. Blair
- Address for correspondence: K. S. Blair, Ph.D., Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 15K North Drive, Room 115A, MSC 2670, Bethesda, MD 20892-2670, USA. ()
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Fry M, Teng C, Lee A, Sun W, Parekh M, Rajadas J, Beachy P, Epstein E, Tang J. LB783 Topical Itraconazole inhibits the Hedgehog signaling pathway and reduces tumor development and size in murine models. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wong CH, Tan TR, Heng Hy HY, Ramesh T, Ting PW, Lee WS, Teng CL, Sivalingam N, Tan KK. Parental preferences with regards to disclosure following adverse events occurring in relation to medication use or diagnosis in the care of their children - perspectives from Malaysia. Med J Malaysia 2016; 71:186-192. [PMID: 27770117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Open disclosure is poorly understood in Malaysia but is an ethical and professional responsibility. The objectives of this study were to determine: (1) the perception of parents regarding the severity of medical error in relation to medication use or diagnosis; (2) the preference of parents for information following the medical error and its relation to severity; and (3) the preference of parents with regards to disciplinary action, reporting, and legal action. METHODS We translated and contextualised a questionnaire developed from a previous study. The questionnaire consisted of four case vignettes that described the following: medication error with a lifelong complication; diagnostic error with a lifelong complication; diagnostic error without lifelong effect; and medication error without lifelong effect. Each case vignette was followed by a series of questions examining the subject's perception on the above areas. We also determined the content validity of the questionnaire. We invited parents of Malaysian children admitted to the paediatric wards of Tuanku Jaafar Hospital to participate in the study. RESULTS One hundred and twenty-three parents participated in the study. The majority of parents wanted to be told regarding the event. As the severity of the case vignettes increased, the desire for information, remedial action, acknowledgement of responsibility, compensation, punishment, legal action, and reporting to a higher agency also increased. The findings did not have strong evidence of a relationship with subject's demographics. CONCLUSION This study gives insights into previously unexplored perspectives and preferences of parents in Malaysia regarding open disclosure. It also highlights the opportunity for more research in this area with potentially broad applications.
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Affiliation(s)
- C H Wong
- International Medical University, Department of Family Medicine, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia.
| | - T R Tan
- International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - H Y Heng Hy
- International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - T Ramesh
- International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - P W Ting
- International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - W S Lee
- International Medical University, IMU Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - C L Teng
- International Medical University, Department of Family Medicine, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - N Sivalingam
- International Medical University, Department of Obstetrics and Gynaecology, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - K K Tan
- Tuanku Jaafar Hospital, Department of Paediatrics, Seremban, Malaysia
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Teng C, Ainsley C, Teo B, Burgdorf B, Janssens G, Berman A, Levin W, Xiao Y, Lin L, Simone C, Solberg T. SU-F-J-64: Comparison of Dosimetric Robustness Between Proton Therapy and IMRT Plans Following Tumor Regression for Locally Advanced Non-Small Cell Lung Cancer (NSCLC). Med Phys 2016. [DOI: 10.1118/1.4955972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Teng C, Janssens G, Ainsley C, Teo B, Valdes G, Burgdorf B, Berman A, Levin W, Xiao Y, Lin L, Gabriel P, Simone C, Solberg T. TU-H-CAMPUS-JeP3-04: Factors Predicting a Need for Treatment Replanning with Proton Radiotherapy for Lung Cancer. Med Phys 2016. [DOI: 10.1118/1.4957702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chow AL, Ang A, Chow CZ, Ng TM, Teng C, Ling LM, Ang BS, Lye DC. Implementation hurdles of an interactive, integrated, point-of-care computerised decision support system for hospital antibiotic prescription. Int J Antimicrob Agents 2015; 47:132-9. [PMID: 26774157 DOI: 10.1016/j.ijantimicag.2015.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/30/2015] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
Abstract
Antimicrobial stewardship is used to combat antimicrobial resistance. In Singapore, a tertiary hospital has integrated a computerised decision support system, called Antibiotic Resistance Utilisation and Surveillance-Control (ARUSC), into the electronic inpatient prescribing system. ARUSC is launched either by the physician to seek guidance for an infectious disease condition or via auto-trigger when restricted antibiotics are prescribed. This paper describes the implementation of ARUSC over three phases from 1 May 2011 to 30 April 2013, compared factors between ARUSC launches via auto-trigger and for guidance, examined factors associated with acceptance of ARUSC recommendations, and assessed user acceptability. During the study period, a monthly average of 9072 antibiotic prescriptions was made, of which 2370 (26.1%) involved ARUSC launches. Launches via auto-trigger comprised 48.1% of ARUSC launches. In phase 1, 23% of ARUSC launches were completed. This rose to 38% in phase 2, then 87% in phase 3, as escapes from the ARUSC programme were sequentially disabled. Amongst completed launches for guidance, 89% of ARUSC recommendations were accepted versus 40% amongst completed launches via auto-trigger. Amongst ARUSC launches for guidance, being from a medical department [adjusted odds ratio (aOR)=1.20, 95% confidence interval (CI) 1.04-1.37] and ARUSC launch during on-call (aOR=1.81, 95% CI 1.61-2.05) were independently associated with acceptance of ARUSC recommendations. Junior physicians found ARUSC useful. Senior physicians found ARUSC reliable but admitted to having preferences for antibiotics that may conflict with ARUSC. Hospital-wide implementation of ARUSC encountered hurdles from physicians. With modifications, the completion rate improved.
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Affiliation(s)
- A L Chow
- Department of Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - A Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Z Chow
- Department of Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - T M Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - C Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - L M Ling
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - B S Ang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - D C Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
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Teng C, Yin L, Ainsley C, Simone C, Teo B, Kassaee A. TU-F-CAMPUS-J-01: Dosimetric Effects of HU Changes During the Course of Proton Therapy for Lung Cancer. Med Phys 2015. [DOI: 10.1118/1.4925806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Norazida AR, Sivasampu S, Teng CL. Cough and cold medication in children: a public health concern. Med J Malaysia 2014; 69:219-223. [PMID: 25638235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The indiscriminate use of cough and cold medicines (CCMs) in children has become a public health concern. The study evaluates the prescription pattern of CCMs in primary care setting. METHODS Analysis of CCMs prescription data among children aged 12 years and below who had participated in the National Medical Care Survey (NMCS) 2010. Data was extracted from NMCS 2010, a cross-sectional survey on the primary healthcare service which was carried out from December 2009 to April 2010 in public and private primary care clinics in Malaysia. RESULT Of 21,868 encounters for NMCS 2010, 3574 (16.3%) were children 12 years old and below; 597 (17%) were from public clinics and 2977 (83%) were from private clinics. Of these 3574 encounters, 1748 (49%) children were prescribed with CCM with total of 2402 CCMs. On average, CCMs were prescribed at a rate of 1.3 CCMs per encounter in public clinics and 1.4 CCMs per encounter in private clinics. CCMs containing single ingredient constituted 77% of the prescriptions while 23% were of multiple ingredient preparations. There were 556 (23%) CCMs prescribed to children younger than 2 years. Majority (65%) were prescribed with one CCM per visit, 32% received two CCMs and 3% of the children received three or more CCMs per visit. CONCLUSION Prescription of CCMs to children is common. Prevalence of CCM prescriptions among young children is of concern, in view of concerns about the safety and adverse effects related to the use of CCMs in this age group. Firmer policies and greater effort is needed to monitor the prescriptions of CCMs to children.
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Affiliation(s)
- A R Norazida
- Ministry of Health Malaysia, Clinical Research Centre, Healthcare Statistics Unit, Malaysia.
| | - S Sivasampu
- Ministry of Health Malaysia, Clinical Research Centre, Healthcare Statistics Unit, Malaysia
| | - C L Teng
- International Medical University, Department of Family Medicine, Malaysia
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Teng C, Chen S, Hu Y, Tzeng C, Chen T. Secondary Primary Malignancy Risk Among Patients with Gastric Cancer: a Nationwide Population-Based Study in Taiwan. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chiang H, Teng C. Risk of Cancer in Patients with Autism Spectrum Disorder: a Nationwide Population-Based Longitudinal Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu352.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Teng CL. Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review. Malays Fam Physician 2014; 9:18-25. [PMID: 25893067 PMCID: PMC4399404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This review highlights the high prevalence of antibiotic use for upper respiratory tract infections (URTIs) in a larger part of the Asia-Pacific region. Since URTIs are one of the common reasons for primary care consultations in this region, inappropriate use of antibiotic in both quantity and drug choice has greatly influenced the development of antibiotic resistance. Notwithstanding the paucity of Asia-Pacific data on the above issues, the available information suggests urgent actions needed to be taken to promote judicious antibiotic use at the point-of-care through a multi-pronged approach targeting the patients/consumers (or parents), healthcare providers and health care systems.
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Affiliation(s)
- CL Teng
- Department of Family Medicine, International Medical University
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Teng CL, Zuhanariah MN, Ng CS, Goh CC. Bibliography of clinical research in malaysia: methods and brief results. Med J Malaysia 2014; 69 Suppl A:4-7. [PMID: 25417946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article describes the methodology of this bibliography. A search was conducted on the following: (1) bibliographic databases (PubMed, Scopus, and other databases) using search terms that maximize the retrieval of Malaysian publications; (2) Individual journal search of Malaysian healthrelated journals; (3) A targeted search of Google and Google Scholar; (4) Searching of Malaysian institutional repositories; (5) Searching of Ministry of Health and Clinical Research Centre website. The publication years were limited to 2000- 2013. The citations were imported or manually entered into bibliographic software Refworks. After removing duplicates, and correcting data entry errors, PubMed's Medical Subject Headings (MeSH terms) were added. Clinical research is coded using the definition "patient-oriented-research or research conducted with human subjects (or on material of human origin) for which the investigator directly interacts with the human subjects at some point during the study." A bibliography of citations [n=2056] that fit the criteria of clinical research in Malaysia in selected topics within five domains was generated: Cancers [589], Cardiovascular diseases [432], Infections [795], Injuries [142], and Mental Health [582]. This is done by retrieving citations with the appropriate MESH terms, as follow: For cancers (Breast Neoplasms; Colorectal Neoplasms; Uterine Cervical Neoplasms), for cardiovascular diseases (Coronary Disease; Hypertension; Stroke), for infections (Dengue; Enterovirus Infections, HIV Infections; Malaria; Nipah Virus; Tuberculosis), for injuries (Accidents, Occupational; Accidents, Traffic; Child Abuse; Occupational Injuries), for mental health (Depression; Depressive Disorder; Depressive Disorder, Major; Drug Users; Psychotic Disorders; Suicide; Suicide, Attempted; Suicidal Ideation; Substance- Related Disorders).
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Affiliation(s)
- C L Teng
- International Medical University, Jln Rasah, Seremban, Negeri Sembilan, Malaysia.
| | - M N Zuhanariah
- International Medical University, Jln Rasah, Seremban, Negeri Sembilan, Malaysia
| | - C S Ng
- International Medical University, Jln Rasah, Seremban, Negeri Sembilan, Malaysia
| | - C C Goh
- International Medical University, Jln Rasah, Seremban, Negeri Sembilan, Malaysia
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Teng CL, Wong CH. Does negative IgM dengue serology rule out dengue fever in an adult with fever for three days? Malays Fam Physician 2013; 8:26-27. [PMID: 25883762 PMCID: PMC4391515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- CL Teng
- Department of Family Medicine, International Medical University
| | - CH Wong
- Department of Family Medicine, International Medical University
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Mastura I, Teng CL, Mimi O, Ho BK, Kusiar Z, Hasim R. Usage of glucometer is associated with improved glycaemic control in type 2 diabetes mellitus patients in Malaysian public primary care clinics: an open-label, randomised controlled trial. Singapore Med J 2013. [DOI: 10.11622/smedj.2013158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zhu Y, Li X, Teng C, Sun B. Enhanced production of α-glucosidase inhibitor by a newly isolated strain of Bacillus subtilis B2 using response surface methodology. Food and Bioproducts Processing 2013. [DOI: 10.1016/j.fbp.2012.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Low WHH, Seet W, A S R, Ng KK, H J, Dan SP, Teng CL, Lee VKM, Chua SS, M Y FA, T K, Chee WSS, Goh PP, M Z, Lim TO. Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial. Med J Malaysia 2013; 68:129-135. [PMID: 23629558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
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Affiliation(s)
- W H H Low
- Clinical Research Center, Clinical Epidemiology Unit, 1st Floor MMA House, 124, Jalan Pahang, Kuala Lumpur 53000 Malaysia.
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Chen Z, Jia H, Yang Y, Yan Q, Jiang Z, Teng C. Secretory expression of a β-xylosidase gene fromThermomyces lanuginosusinEscherichia coliand characterization of its recombinant enzyme. Lett Appl Microbiol 2012; 55:330-7. [DOI: 10.1111/j.1472-765x.2012.03299.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lai NM, Teng CL, Nalliah S. Assessing undergraduate competence in evidence based medicine: a preliminary study on the correlation between two objective instruments. Educ Health (Abingdon) 2012; 25:33-39. [PMID: 23787382 DOI: 10.4103/1357-6283.99204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT The Fresno test and the Berlin Questionnaire are two validated instruments for objectively assessing competence in evidence-based medicine (EBM). Although both instruments purport to assess a comprehensive range of EBM knowledge, they differ in their formats. We undertook a preliminary study using the adapted version of the two instruments to assess their correlations when administered to medical students. The adaptations were made mainly to simplify the presentation for our undergraduate students while preserving the contents that were assessed. METHODS We recruited final-year students from a Malaysian medical school from September 2006 to August 2007. The students received a structured EBM training program within their curriculum. They took the two instruments concurrently, midway through their final six months of training. We determined the correlations using either the Pearson's or Spearman's correlation depending on the data distribution. RESULTS Of the 120 students invited, 72 (60.0%) participated in the study. The adapted Fresno test and the Berlin Questionnaire had a Cronbach's alfa of 0.66 and 0.70, respectively. Inter-rater correlation (r) of the adapted Fresno test was 0.9. The students scored 45.4% on average [standard deviation (SD) 10.1] on the Fresno test and 44.7% (SD 14.9) on the Berlin Questionnaire (P = 0.7). The overall correlation between the two instruments was poor (r = 0.2, 95% confidence interval: -0.07 to 0.42, P = 0.08), and correlations remained poor between items assessing the same EBM domains (r = 0.01-0.2, P = 0.07-0.9). DISCUSSION The adapted versions of the Fresno test and the Berlin Questionnaire correlated poorly when administered to medical students. The two instruments may not be used interchangeably to assess undergraduate competence in EBM.
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Affiliation(s)
- N M Lai
- Department of Paediatrics, Monash University Sunway Campus, Jeffrey Cheah School of Medicine and Health Sciences, Malaysia.
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Grim SA, Berger K, Teng C, Gupta S, Layden JE, Janda WM, Clark NM. Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother 2011; 67:707-14. [DOI: 10.1093/jac/dkr511] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Teng C, Teng H, Yang Y, Yen C, Lin T, Lin J, Chen W, Tzeng C, Wang W. Use of duloxetine for oxaliplatin-induced neuropathic pain in patients with colorectal cancer: An open-label pilot study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Demartino R, Feuer B, Jacobson S, Karim D, Khanarian G, Stamatoff J, Teng C, Yoon H. Non-Linear Optical Polymers for Active Optical Devices. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-134-641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Second order non-linear optical (NLO) polymers have been the focus of intense research effort in recent years [1]. This effort is justified by the potential value of these materials in a range of attractive optical signal processing applications with lower device costs and enhanced device performance.
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Lai NM, Teng CL. Competence in evidence-based medicine of senior medical students following a clinically integrated training programme. Hong Kong Med J 2009; 15:332-338. [PMID: 19801689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To assess the impact of a structured, clinically integrated evidence-based undergraduate medicine training programme using a validated tool. DESIGN. Before and after study with no control group. SETTING A medical school in Malaysia with an affiliated district clinical training hospital. PARTICIPANTS Seventy-two medical students in their final 6 months of training (senior clerkship) encountered between March and August 2006. INTERVENTION Our educational intervention included two plenary lectures at the beginning of the clerkship, small-group bedside question-generating sessions, and a journal club in the paediatric posting. MAIN OUTCOME MEASURES Our primary outcome was evidence-based medicine knowledge, measured using the adapted Fresno test (score range, 0-212) administered before and after the intervention. We evaluated the performance of the whole cohort, as well as the scores of different subgroups that received separate small-group interventions in their paediatric posting. We also measured the correlation between the students' evidence-based medicine test scores and overall academic performances in the senior clerkship. RESULTS Fifty-five paired scripts were analysed. Evidence-based medicine knowledge improved significantly post-intervention (means: pre-test, 84 [standard deviation, 24]; post-test, 122 [22]; P<0.001). Post-test scores were significantly correlated with overall senior clerkship performance (r=0.329, P=0.014). Lower post-test scores were observed in subgroups that received their small-group training earlier as opposed to later in the clerkship. CONCLUSIONS Clinically integrated undergraduate evidence-based medicine training produced an educationally important improvement in evidence-based medicine knowledge. Student performance in the adapted Fresno test to some extent reflected their overall academic performance in the senior clerkship. Loss of evidence-based medicine knowledge, which might have occurred soon after small-group training, is a concern that warrants future assessment.
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Affiliation(s)
- N M Lai
- Department of Paediatrics, School of Medicine and Health Sciences, Monash University Malaysia, JKR 1235, Bukit Azah, 80100, Johor Bahru, Johor Darul Takzim, Malaysia.
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Das Gupta E, Zailinawati AH, Lim AW, Chan JB, Yap SH, Hla YY, Kamil MA, Teng CL. Are Indians and females less tolerant to pain? An observational study using a laboratory pain model. Med J Malaysia 2009; 64:111-113. [PMID: 20058568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In Malaysia, it is a common belief among health care workers that females and Indians have lower pain threshold. This experience, although based on anecdotal experience in the healthcare setting, does not allow differentiation between pain tolerance, and pain expression. To determine whether there is a difference in the tolerance to pain between the three main ethnic groups, namely the Malays, Chinese and Indians as well as between males and females. This was a prospective study, using a laboratory pain model (ischaemic pain tolerance) to determine the pain tolerance of 152 IMU medical students. The mean age of the students was 21.8 years (range 18-29 years). All of them were unmarried. The median of ischaemic pain tolerance for Malays, Chinese and Indians were 639s, 695s and 613s respectively (p = 0.779). However, statistically significant difference in ischaemic pain tolerance for males and females Indian students were observed. Possible ethnic difference in pain tolerance in casual observation is not verified by this laboratory pain model. Difference in pain tolerance between genders is shown only for Indians.
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Affiliation(s)
- E Das Gupta
- International Medical University, Clinical School, 70300 Seremban, Negeri Sembilan, Malaysia.
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Zailinawati AH, Teng CL, Chung YC, Teow TL, Lee PN, Jagmohni KS. Daytime sleepiness and sleep quality among Malaysian medical students. Med J Malaysia 2009; 64:108-110. [PMID: 20058567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Poor sleep quality and daytime somnolence is reported to be associated with cardiovascular events, road traffic accident, poor academic performance and psychological distress. Some studies documented that it is prevalent in most populations but its frequency among medical students has not been documented in Malaysia. This is a self-administered questionnaire survey of medical students from International Medical University, Malaysia. Daytime sleepiness of medical students was assessed using Epworth Sleepiness Scale (ESS). Student scoring ESS > 11 was regarded as having excessive daytime sleepiness. Psychological distress was measured using 12-item General Health Questionnaire (GHQ-12). A total of 799 medical students participated in this survey (response rate 69.5%). Daytime sleepiness occurred in 35.5%, psychological distress was present in 41.8% and 16.1% reported bad sleep quality. Daytime sleepiness was significantly more common among the clinical students, those with self-reported bad sleep quality and psychological distress; but unrelated to the number of hours sleep at night. We have documented high prevalence of daytime sleepiness, poor sleep quality and psychological distress. Higher frequency among clinical students and the significant relationship with psychological distress suggest possible link to the stressful clinical training.
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Affiliation(s)
- A H Zailinawati
- International Medical University, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia.
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Teng CL, Kunjapan SR. Frequent Ventricular Ectopics in a Healthy Adult Woman - is it Associated with Sudden Cardiac Death? Malays Fam Physician 2008; 3:156-157. [PMID: 25606142 PMCID: PMC4170360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- CL Teng
- MMed (FamMed), FRACGP, FAFPM, FAMM. International Medical University, Seremban, Malaysia
| | - SR Kunjapan
- FRCP. Senior Consultant, Department of Medicine, Hospital Tuanku Jaafar, Seremban, Malaysia
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Mastura I, Teng CL. The effect of "group detailing" on drug prescribing in primary care. Med J Malaysia 2008; 63:315-318. [PMID: 19385492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The quality of physician prescribing is suboptimal. Patients are at risk of potentially adverse reaction because of inappropriate or writing error in the drug prescriptions. We assess the effect of "group academic detailing" to reduce writing drug name using brand name and short form in the drug prescriptions in a controlled study at two primary health care clinics in Negeri Sembilan. Five medical officers in Ampangan Health Clinic received an educational intervention consisting of group academic detailing from the resident Family Medicine Specialist, as well as a drug summary list using generic names. The academic detailing focused on appropriate prescribing habit and emphasized on using the full generic drug name when writing the drug prescription. Analyses were based on 3371 prescriptions that were taken from two clinics. The other health clinic was for comparison. The prescribing rates were assessed by reviewing the prescriptions (two months each for pre- and post-intervention phase). Statistically significant reduction in writing prescription using brand name and using short form were observed after the educational intervention. Writing prescription using brand name for pre- and postintervention phase were 33.9% and 19.0% (postintervention vs pre-intervention RR 0.56, 95% CI 0.48 to 0.66) in the intervention clinic. Prescription writing using any short form for pre- and post-intervention phase were 49.2% and 29.2% (post-intervention vs pre-intervention RR 0.59, 95% CI 0.53 to 0.67). This low cost educational intervention focusing on prescribing habit produced an important reduction in writing prescription using brand name and short form. Group detailing appears to be feasible in the public health care system in Malaysia and possibly can be used for other prescribing issues in primary care.
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Affiliation(s)
- I Mastura
- Kuala Pilah Health Clinic, 72000 Kuala Pilah, Negeri Sembilan, Malaysia
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Zailinawati AH, Ariff KM, Nurjahan MI, Teng CL. Epidemiology of Insomnia in Malaysian Adults: A Community-Based Survey in 4 Urban Areas. Asia Pac J Public Health 2008; 20:224-33. [DOI: 10.1177/1010539508316975] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to determine the prevalence and pattern of insomnia in a Malaysian population aged 30 to 70 years. The sample consisted of 1611 subjects, recruited by stratified random sampling and interviewed using a semistructured questionnaire conducted in 2004. This was a community-based survey in 4 Malaysian states. The prevalence of insomnia symptom was 33.8%, and 12.2% of the subjects had chronic insomnia. Insomnia was more common among elderly; those who were separated, divorced, or widowed; and those who smoked at bedtime. Subjects with insomnia had a higher prevalence of feeling depressed (12.7), loss of concentration (19.1%), exhaustion (17.2%), poor memory (9.2%), decreased work productivity (6.4%), and perceived poor health status (40.9%; all, P < .05). A total of 22.2% of those with insomnia had excessive daytime sleepiness based on their Epworth Sleepiness Score ( P = <.001). Those with insomnia used more sedatives (9.9%) compared with those without insomnia (2.6%; P < .001). About one-third of the population had insomnia associated with impaired daily function. This study concluded that insomnia is common in Malaysian adult population, and it has significant impact on psychological well being and daily functioning.
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Affiliation(s)
- AH Zailinawati
- International Medical University, Jalan, Kuala Lumpur,
Malaysia,
| | | | - MI Nurjahan
- International Medical University, Jalan, Kuala Lumpur,
Malaysia
| | - CL Teng
- International Medical University, Jalan, Kuala Lumpur,
Malaysia
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Abstract
Universally, mothers often use touching to detect fever in their children. We perform a systematic review of published diagnostic studies evaluating the ability of mothers to detect fever in their children by touching. We found 10 studies satisfying our inclusion criteria. The meta-analysis revealed a summary sensitivity of 89.2% and summary specificity of 50%-maternal touch is perhaps more useful to exclude fever rather than to 'rule in' fever. However, due to significant heterogeneity in the included studies, interpretation of the summary data is difficult.
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Affiliation(s)
- C L Teng
- Department of Family Medicine, International Medical University, Seremban, Negeri Sembilan, Malaysia.
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Leong KC, Teng CL. General practice consultations. Aust Fam Physician 2007; 36:679-680. [PMID: 17918303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Vasanthakumar SS, Teng CL. Should Statins Be Started In All Type 2 Diabetics Irrespective of LDL-Cholesterol Level? Malays Fam Physician 2007; 2:74-75. [PMID: 25606085 PMCID: PMC4170335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | - CL Teng
- MMed(FamMed), FAFPM, FRACGP, AM
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40
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Leong KC, Teng CL, Ng CJ. Learning resources and activities: students' feedback from two Malaysian medical schools. Med J Malaysia 2007; 62:265-267. [PMID: 18246926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In a survey of clinical students in two Malaysian medical schools, it was found that students used a wide variety of learning resources, but textbooks were still the primary source of their information. Students had positive views about clinical teaching and lectures but somewhat lower opinions on problem-based learning. They generally did not perceive lecturers as facilitators, role models and counselors. In spite of the stated curricular goals of promoting self-directed learning via problem-based learning, students in these medical schools were driven by the nature of examinations and focused mainly on clinical contents rather than the process of learning.
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Affiliation(s)
- K C Leong
- Department of Family Medicine, International Medical University, Kuala Lumpur
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Mastura I, Mimi O, Piterman L, Teng CL, Wijesinha S. Self-monitoring of blood glucose among diabetes patients attending government health clinics. Med J Malaysia 2007; 62:147-151. [PMID: 18705449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aims of this study were (i) to determine the prevalence of self-monitoring of blood glucose (SMBG) among Type 2 diabetes patients attending government health clinics and (ii) to ascertain the factors influencing SMBG. Five hundred and fifty-six Type 2 diabetes patients from two government health clinics in Selangor and Negeri Sembilan were interviewed using a structured questionnaire. The total subjects of the study were 556 patients. Eighty-five patients (15.3%) of patients; performed SMBG. However, 170 subjects were included in the statistical analysis, 85 patients who were not self-monitoring were randomly selected and was compared with 85 patients who were self-monitoring. Among those who performed SMBG, the majority (83.5%) monitored less than once per day and only 16.5% monitored at least once a day. One-third of patients adjusted their medications based on their SMBG results. The higher patient's level of education (p= 0.024, CI 1.29 - 35.3); the higher total family income (p= 0.041, CI 1.26 - 4.79); the longer duration of diabetes (p<0.01, CI 2.22 - 7.29); and treatment regime which includes insulin (p< 0.001, CI 2.05 -9.24) were significant predictors of SMBG practice. Although SMBG is recognised to be useful and effective in achieving diabetes control, this study has found that only a minority of patients with diabetes performed SMBG. Hence healthcare personnel must increase awareness on the importance of SMBG and strongly promote the practice among diabetic patients.
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Affiliation(s)
- I Mastura
- Kuala Pilah Health Clinic, Kuala Pilah, Negeri Sembilan, Malaysia
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Abstract
AIM Fever in children, a mostly benign and self-limiting illness, is often viewed with consternation by the care givers. It results in early consultation and excessive use of antipyretics and antibiotics. In this study, we document the prescribing practice of doctors from three primary care settings in Malaysia and identify the predictors of antibiotic prescription. METHODS Interview of care givers bringing febrile children (age </= 12 years) to three primary care settings: public primary care clinics, private general practice clinics and a university-based primary care clinic. RESULTS Data from 649 children were analysed. Mean age of children 4.1 years and 55% were boys. One-third of the children had prior consultation for the same episode of fever. About 80% of the febrile children were diagnosed to have upper respiratory tract infection, viral fever and gastroenteritis. Overall antibiotic prescribing rate was 36.6% (public primary care clinic 26.8%, private general practice clinic 70.0% and university-based primary care clinic 32.2%). Independent predictors of antibiotic prescription were: clinic setting, longer duration of fever (>7 days), higher temperature (>38 degrees C) and the diagnosis of upper respiratory tract infections. After controlling for demographic and clinical factors, antibiotic prescription in private general practice clinic was seven times higher than public primary care clinic (odds ratio 7.1, 95% confidence interval 4.0-12.7), and 1.6 times higher than university-based primary care clinic (odds ratio 1.6, 95% confidence interval 1.0-2.5). CONCLUSION Differences in the patients' demographic and clinical characteristics could not adequately explain the high antibiotic prescribing rate in private general practice clinics. This inappropriately high antibiotic prescribing for febrile children in private general practice clinics is a suitable target for future intervention.
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Affiliation(s)
- C L Teng
- Department of Family Medicine, International Medical University, Seremban, Malaysia
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Ding CH, Teng CL, Koh CN. Knowledge of diabetes mellitus among diabetic and non-diabetic patients in Klinik Kesihatan Seremban. Med J Malaysia 2006; 61:399-404. [PMID: 17243515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Malaysian Ministry of Health has undertaken various campaigns on healthy lifestyle and health promotion over the years. The impact of these campaigns has been mixed and not well documented. This cross-sectional study evaluated the knowledge level of patients with and without diabetes in a large urban polyclinic using a 41-item questionnaire. One hundred and forty-nine adults (83 with diabetes, 66 without diabetes) participated in this study. Patients with diabetes had higher overall knowledge scores than those without diabetes (81.8% vs 64.0%, p < 0.001). While the overall knowledge of patients without diabetes appeared to be acceptable, several areas of knowledge deficiency were identified in this group--areas that should be filled by the on-going health promotion activities.
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Affiliation(s)
- C H Ding
- IMU Clinical School, International Medical University, Jalan Rasah, 70300 Seremban, Negeri Sembilan Darul Khusus
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Teng CL, Achike FI, Phua KL, Nurjahan MI, Mastura I, Asiah HN, Mariam AM, Narayanan S, Norsiah A, Sabariah I, Shariah I, Rokiah KS, Zubaidah MAS, Koh CN, Rosnah I. Modifying antibiotic prescribing: the effectiveness of academic detailing plus information leaflet in a Malaysian primary care setting. Med J Malaysia 2006; 61:323-31. [PMID: 17240584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We assessed the effectiveness of an educational intervention in reducing antibiotic prescribing in public primary care clinics in Malaysia. Twenty-nine medical officers in nine clinics received an educational intervention consisting of academic detailing from the resident Family Medicine Specialist, as well as an information leaflet. The antibiotic prescribing rates were assessed for six months - three months before and three months after the intervention. A total of 28,562 prescriptions were analyzed. Among participating doctors, general antibiotic prescribing rates for pre- and post-intervention phases were 14.3% and 11.0% (post-intervention vs pre-intervention RR 0.77, 95% CI 0.72 to 0.83). The URTI-specific antibiotic prescribing rates for pre- and post-intervention phases were 27.7% and 16.6%, respectively (post-intervention vs pre-intervention RR 0.60, 95% CI 0.54 to 0.66). No significant change in antibiotic prescribing rates was observed among primary care practitioners who did not participate in the study. This low cost educational intervention using both active and passive strategies focusing on URTI produced a statistically significant (and clinically important) reduction in antibiotic prescribing.
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Affiliation(s)
- C L Teng
- International Medical University, Negeri Sembilan, Darul Khusus, Malaysia
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Zailinawati AH, Teng CL, Kamil MA, Achike FI, Koh CN. Pain morbidity in primary care - preliminary observations from two different primary care settings. Med J Malaysia 2006; 61:162-7. [PMID: 16898306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.
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Affiliation(s)
- A H Zailinawati
- International Medical University, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
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Chan GC, Teng CL. Primary care doctors' perceptions towards evidence-based medicine in Melaka State: a questionnaire study. Med J Malaysia 2005; 60:130-3. [PMID: 16114151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conclucted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.
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Affiliation(s)
- G C Chan
- Family Medicine Specialist, Poliklinik Komuniti Peringgit, Jalan Pantai Peringgit, 75400 Melaka
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Teng CL, Achike FI, Phua KL, Norhayati Y, Nurjahan MI, Nor AH, Koh CN. General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting. Int J Antimicrob Agents 2005; 24:496-501. [PMID: 15519484 DOI: 10.1016/j.ijantimicag.2004.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 06/30/2004] [Indexed: 10/26/2022]
Abstract
Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.
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Affiliation(s)
- C L Teng
- Sesama Centre, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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Loh LC, Teng CL, Teh PN, Koh CN, Vijayasingham P, Thayaparan T. Metered-dose inhaler technique in asthmatic patients--a revisit of the Malaysian scene. Med J Malaysia 2004; 59:335-41. [PMID: 15727379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Inefficient metered-dose inhaler (MDI) technique results in poor drug delivery, suboptimal disease control a possibility of inhaled medication overuse. The MDI technique of 134 government hospital and clinic followed-up adult asthmatic patients followed-up in a government hospital and a heath clinic was pragmatically assessed based on the 3 obligatory steps of adequate lip seal, appropriate hand-breath coordination and sufficient breath holding after inhalation. The relationship between technique efficiency and frequency of daily short-acting beta2-agonist (SABA) use via the MDI and asthma exacerbations over a 12-month period was also assessed. Fifty-six patients (42%) had inefficient MDI technique. All demographic and asthma-related variables between the 'efficient' and 'inefficient' technique groups of patients were comparable except for significantly longer mean years of MDI use in the 'efficient' technique group [mean (SD): 10 (7) vs. 7 (5); p=0.003]. There were no significant differences between the two groups in relation to frequency of daily SABA use or asthma exacerbations over the past 12 months. Despite having been available in Malaysia for a considerable period of time, the MDI device is still poorly handled by a large proportion of adult asthmatic patients. Changing to other more user-friendly devices or use of spacer devices to facilitate delivery should be considered for these patients.
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Affiliation(s)
- L C Loh
- IMU Lung Research, International Medical University, Clinical School, Hospital Seremban, Seremban, Negeri Sembilan, Malaysia
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Khoo EM, Teng CL, Wong KC. Are doctors in the university-based primary care clinic more evidence-based? Med J Malaysia 2004; 59:129. [PMID: 15535352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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