BackgroundEvidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice.AimThis study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting.MethodsQualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach.ResultsKey themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings.ConclusionThe level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.
Summary: Although low density lipoprotein receptors have been described on oligodendrocytes, apolipoprotein B was thought to be absent or present in only very small amounts in cerebrospinal fluid (CSF). Several immunoassays have been used for the measurement of apolipoprotein B in serum. However, the majority of methods cannot be used to measure small amounts of apolipoprotein B in CSF. In this study, we describe a highly sensitive time resolved immunoftoorometric assay (TR-IFMA) using europium as label (detection limit: 0,3 g/l). The reliability of the TR-IFMA for the measurement of apolipoprotein B was first studied in serum. Serum and CSF apolipoprotein B concentrations were then determined in subjects free of neurological disorders and in patients with multiple sclerosis. Local intrathecal apolipoprotein B synthesis was calculated. Although the high sensitivity of the TR-IFMA allowed low amounts of apolipoprotein B in CSF to be detected (0.11 ± 0.06; 0.12 ± 0.06 mg/1 in controls and multiple sclerosis patients, respectively), no apolipoprotein B could be detected in CSF by electroimmunodiffusion. As suggested by the blood/CSF apolipoprotein B ratio (about 6000), no apolipoprotein B synthesis was observed by both using apolipoprotein B index and formula. This indicates its probable serum origin. Moreover, there was no difference between controls and multiple sclerosis patients in CSF, serum, blood/CSF, index, and local intrathecal apolipoprotein B synthesis. Finally, these results suggest that the role of apolipoprotein B in lipid transport in the central nervous system may be questionable.
Introduction: Evidences on the bilateral relationship between diabetes mellitus (DM) and periodontal diseases (PD) have been growing. Oral hygiene practice (OHP) is one of major determinants for PD. Thus, the aim of this study was to assess periodontal disease status and oral hygiene practices of DM-patients from public medical primary care clinics (PMPCCs). Methods: A medical-dental research team conducted an active PD-screening among 193 DMpatients using both self-reported questions (SRQs) and basic periodontal examination (BPE) by professionals at 3-PMPCCs in Kuantan in 2015. OHP was categorized into two groups; acceptable OHP (two/three-time tooth-brushing/day using with/without mouthwash/flossing) and need to improve OHP (one-time tooth brushing/day using with/without mouth-wash/flossing). HbA1C ≤ 6.5% was used as cut-off for glycaemic control achievement. A cross- analysis was done to infer the influences of demographic-background and OHP on PD- status and relationship between PD- status and glycaemic control achievement. Results: Out of 193 DM-patients, 72.5% (140/193) were PD-screening positive in self-reporting while 54.9% (106/193) had PD in professional screening. OHP of majority (86%) were acceptable. Only 14% (27/193) achieved glycaemic-control status. Influence of demographic and OHP on PD-status ( by BPE) and relationship between PD and glycaemic control achievement did not found out. There were no age and race difference in OHP; however, acceptable OHP was significantly higher (p<0.05) in female than male DM-patients (94% vs 77.4%). Conclusions: High prevalence of PD indicated to promote oral health education/care among DM-patients from PMPCCs. In-detailed OHP/PD assessment and other influencing factors on glycaemic-control achievement should be considered to get more valid results in further study.
Essential thrombocythemia (ET) is one of the myeloproliferative neoplasms which typically presents with thrombotic vasomotor symptoms or bleeding tendencies. Papular rash is a rare manifestation of ET and may cause delay in making the diagnosis and hence institution of the treatment. We report a case of ET in a 50- year-old gentleman, who presented with nonspecific localized erythematous papular rash over his right thigh associated with recurrent mild pain in the affected thigh for one year. He was not any drugs prior to the onset of the rash. He had no history suggestive of haematological disorder such as bleeding tendencies, recurrent fever or anaemic symptoms. He also had no constitutional symptoms or any palpable masses. He was managed conservatively initially at primary care clinic but the problem persisted. A full blood count was subsequently performed which revealed an isolated thrombocytosis of 880 x 109 /L. He was referred to the haematology team for the further management and a diagnosis of ET was then made. Both the platelet counts and the lesion improved with hydroxyurea treatment. This case report illustrates a rare chronic manifestation of myeloproliferative neoplasm detected at a primary care clinic.
Introduction: Defaulted appointment in diabetic clinics is a great concern as it affects disease controlled and complications. Geographical location, clinic-types and quality of health services provided are known determinant reasons for defaulting. Thus, this study aimed to identify characteristics and reasons for default between diabetic-patients at public-primary-care-clinics (PPCCs) and public-hospital-diabetic-specialist-clinic (DS-OPD). Methods: A prospective one-year-cohort study was conducted among 405 diabetic patients from two PPCCs and DS-OPD in Kuantan (2015-2016). There were 2-point visits (at 6-month and 12-month) assessing follow-up appointments within one year. Defaulter is defined by at least one-time defaulted either at 6-month or 12-month. Regular-attendees were included as control. Type-1-DM-patients, missing-records, known-deceased and transferout cases were excluded. Background socio-demographic data of diabetic-defaulters were collected from DM-records and reasons for defaulting were traced via 3-times-telephone contacts which 51.6% diabetic-defaulters responded. A stratified cross-analysis was done to compare the prevalence and characteristics between defaulters and regular attendees. Reasons for defaults were analyzed using open-ended-questions analysis method. Results: Prevalence of defaulters was 18% (73/405); higher prevalence was found in DS-OPD than PPCCs (32.4% vs 10.3%). Gender, race, age, education, occupation and the duration of DM were not significantly different between defaulters and regular-attendees at DS-OPD. However, self-employment (25.9%), housewives (25.9%), aged less than 45-years (33.3%) and≥ 55 years-old (44.4%) were significant defaulters in PPCCs. Significant different of reasons for default found at DS-OPD compare to PPCCs for postponing the date (54.5% vs 12.5%), while refusing treatment/used alternative medicine (18.2% vs 43.8%); and movedout/transferred/referred cases (27.3% vs 31.2%) were more in PPCCs. Conclusions: Distinctive characteristics and diverse reasons for default between DS-OPD and PPCCs among diabetic-patients fortified to set tailored remedial to reduce defaulter-rate in different clinic.
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