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Background and AimTransient elastography (TE) and point shear wave elastography (pSWE) are noninvasive methods to diagnose fibrosis stage in patients with chronic liver disease. The aim of this study is to compare the accuracy of the two methods to diagnose fibrosis stage in non‐alcoholic fatty liver disease (NAFLD) and to study the intra‐observer and inter‐observer variability when the examinations were performed by healthcare personnel of different backgrounds.MethodsConsecutive NAFLD patients who underwent liver biopsy were enrolled in this study and had two sets each of pSWE and TE examinations by a nurse and a doctor on the same day of liver biopsy procedure. The medians of the four sets of pSWE and TE were used for evaluation of diagnostic accuracy using area under receiver operating characteristic curve (AUROC). Intra‐observer and inter‐observer variability was analyzed using intraclass correlation coefficients.ResultsData for 100 NAFLD patients (mean age 57.1 ± 10.2 years; male 46.0%) were analyzed. The AUROC of TE for diagnosis of fibrosis stage ≥ F1, ≥ F2, ≥ F3, and F4 was 0.89, 0.83, 0.83, and 0.89, respectively. The corresponding AUROC of pSWE was 0.80, 0.72, 0.69, and 0.79, respectively. TE was significantly better than pSWE for the diagnosis of fibrosis stages ≥ F2 and ≥ F3. The intra‐observer and inter‐observer variability of TE and pSWE measurements by the nurse and doctor was excellent with intraclass correlation coefficient > 0.96.ConclusionTransient elastography was significantly better than pSWE for the diagnosis of fibrosis stage ≥ F2 and ≥ F3. Both TE and pSWE had excellent intra‐observer and inter‐observer variability when performed by healthcare personnel of different backgrounds.

Objectives This study aimed to investigate the psychological distress and its associated factors among cancer survivors in Malaysia during the COVID-19 pandemic. Methods An anonymous Internet-based study was conducted between 23 April and 26 June 2020. During the study period, the country underwent phase 3 and phase 4 of the Movement Control Order (MCO), Conditional Movement Control Order (CMCO), and Recovery Movement Control Order (RMCO). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), which is a 14-item self-assessment scale for measuring distress (total HADS score; HADS-T) with two subscales, namely, anxiety (HADS-A) and depression (HADS-D). Perceived threat of infection was measured based on the health belief model. Results From a total of 631 responses received, the proportion of participants with anxiety and depression symptoms (above threshold score of 8 on HADS-A and HADS-D) was 29.0 and 20.9%, respectively. Psychological distress (HADS-T > 16) was reported in 22.3% of the respondents. A total of 16.5% had combined anxiety and depression symptoms. The highest HADS-A (6.10; 95% CI 5.64-6.56), HADS-D (5.61; 95% CI 5.14-6.08), and HADS-T (11.71; 95% CI 10.84-12.58) scores were reported among respondents during phase 4 of the MCO. Partial least square-based structural equation modelling (PLS-SEM) revealed that self-perceived health status, perceived susceptibility, and severity of COVID-19 have the greatest effect, leading to higher HADS-A, HADS-D, and HADS-T scores. Conclusion Heightened psychological distress was evident in cancer survivors particularly during the enforcement of the MCO over COVID-19. Providing support to address cancer survivors' psychological and emotional needs during the COVID-19 pandemic is essential.

Background & aim We studied FibroTouch (FT) and Fibroscan (FS) examination results and their repeatability when performed by healthcare personnel of different background. Methods FT and FS examinations were performed on patients with chronic liver disease by two operators, a doctor and a nurse, twice on each patient, at two different time points, independent of each other. Results The data for 163 patients with 1304 examinations was analyzed. There was strong correlation between FT and FS for attenuation parameter (Spearman’s rho 0.76, p<0.001) and liver stiffness measurement (LSM) (Spearman’s rho 0.70, p<0.001). However, FT produced higher value at lower attenuation parameter and LSM, and lower value at higher attenuation parameter and LSM. There was substantial agreement when using 15kPa LSM cut-off, but only moderate agreement when using 10kPa and 20kPa LSM cut-offs and 248dB/m, 268dB/m and 280dB/m attenuation parameter cut-offs. The IQR for attenuation parameter and IQR/median for LSM were significantly lower for FT compared with FS (4dB/m vs 27dB/m, p<0.001, and 10 vs 12, p<0.001, respectively). The intra- and inter-observer reliability of attenuation parameter and LSM using FT and FS were good to excellent with intraclass correlation coefficients 0.89–0.99. FT had shorter examination time (33s vs 47s, p<0.001) and less invalid measurements (0 vs 2, p<0.001). Conclusion Measurements obtained with FT and FS strongly correlated, but significant differences in their absolute values, consistency, examination time and number of invalid measurements were observed. Either device can be used by healthcare personnel of different backgrounds when sufficiently trained.

Bariatric surgery offers a therapeutic alternative with favourable weight management, cardiovascular, metabolic and functional outcomes. Bariatric individuals often have functional impairments pre-operatively that can be addressed to improve post-operative results and eventual functional independence. Multidisciplinary team offers the best approach to address peri-operative needs and sustainable weight loss thereafter. We exemplified the application of cardiac rehabilitation therapeutic model in managing two bariatric clients with specific bariatric-related challenges. Our approach focuses on adaptive physical activity, sustainable lifestyle changes to promote post-operative weight loss through education and problem solving as well as secondary prevention of cardiovascular disease. Putting emphasis on addressing physical and psychosocial barriers towards physical activity alongside nutritional aspects potentially confers sustained if not better outcomes on weight reduction and functional improvement.

ContextNumerous studies have shown that gratitude can reduce stress and improve quality of life.ObjectiveOur study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer.MethodsWe conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43).ResultsAfter 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=−2.0, 95% CI=−2.7 to −1.4, t=−6.125, p=0.000) and the control group (mean difference in overall suffering score=−1.6, 95% CI=−2.3 to −0.8, t=−4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=−3.4, 95% CI=−5.3 to −1.5, t=−3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group.ConclusionThe results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer.Trial registration numberThe trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1261800172191) and conducted in accordance with the Declaration of Helsinki.

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Purpose: This study aimed to investigate the psychological distress and its associated factors among cancer survivors in Malaysia during the COVID-19 pandemic.Methods: An anonymous Internet-based study was conducted between 23 April and 26 June 2020. During the study period, the country underwent Phase 3 and Phase 4 of the Movement Control Order (MCO), Conditional Movement Control Order (CMCO), and Recovery Movement Control Order (RMCO). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), which is a 14-item self-assessment scale for measuring distress (total HADS score (HADS-T)) with two subscales, namely anxiety (HADS-A) and depression (HADS-D). Results: From a total of 631 responses received, the proportion of participants with abnormal anxiety and depression was 29.0% and 20.9%, respectively. Distress was reported in 23.0% of the respondents. A total of 16.45% had combined abnormal anxiety and depression. The highest HADS-A (6.10; 95% CI 5.64‒6.56), HADS-D (5.61; 95% CI 5.14‒6.08), and HADS-T (11.71; 95% CI 10.84‒12.58) scores were reported among respondents during Phase 4 of the MCO. Partial least squares-based structural equation modelling (PLS-SEM) revealed that self-perceived health status, perceived susceptibility, and severity of COVID-19 have the greatest effect, leading to higher HADS-A, HADS-D, and HADS-T scores. Conclusion: Heightened psychological distress was evident in cancer survivors particularly during the enforcement of the MCO over COVID-19. Providing support to address cancer survivors’ psychological and emotional needs during the COVID-19 pandemic is essential.Implication for cancer survivors: Cancer survivors or their carers should be made aware of the high psychological risk during infectious disease outbreaks and seek timely support.