This study was made possible with research funding from University of Malaya (reference F0381/2005C) and University Kebangsaan Malaysia (reference FF-225-2005) Ethics committeeMedical ethics committee -University of Malaya Medical Centre (reference 454.3) and medical ethics committeeUniversiti Kebangsaan Malaysia (reference FF-225-2005)

BackgroundThe chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting.MethodsThis was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect.ResultsA total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. control: 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. control: −4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34–3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes.ConclusionsThis study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting.Trial registrationRegistered with: ClinicalTrials.gov.: NCT01545401. Date of registration: 1st March 2012. Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0557-1) contains supplementary material, which is available to authorized users.

BackgroundInvolving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia.MethodsIn this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation.ResultsThere are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan.ConclusionIn summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

Introduction Sexual dysfunction in men, such as erectile dysfunction, hypogonadism, and premature ejaculation, generates considerable attention. Its association with physical and psychological health is an issue which should be addressed seriously. Aim A review of the literature pertaining to the correlation between sexual dysfunction and physical and psychological health. Methods PubMed search for relevant publications on the association between sexual dysfunction in men and physical and psychological health. Main Outcome Measure Clinical and epidemiological evidence that demonstrates the association between sexual dysfunction in men and physical and psychological health. Results Sexual dysfunction, i.e., erectile dysfunction, hypogonadism, and premature ejaculation, has been shown to be associated with physical and psychological health. There is a strong correlation between sexual dysfunction and cardiovascular disease, metabolic syndrome, quality of life, and depression. Conclusion The association between men’s sexual dysfunction and physical and psychological health is real and proven. Therefore, it should not be taken lightly but instead treated as a life-threatening medical problem.

BackgroundChronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol.Methods/DesignA pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients’ assessment of their chronic disease care and providers’ perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated.DiscussionResults from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia.Trial RegistrationClinicalTrials.gov NCT01545401

Objective• To evaluate the efficacy and safety of long-acting i.m.testosterone undecanoate (TU) in Malaysian men with testosterone deficiency (TD). Patients and Methods• A total of 120 men, aged 40-70 years, with TD (serum total testosterone [TT] Յ 12 nmol/L) were randomised to receive either i.m. TU (1000 mg) or placebo.• In all, 58 and 56 men in the placebo and treatment arm, respectively, completed the study.• Participants were seen six times in the 48-week period and the following data were collected: physical examination results, haemoglobin, haematocrit, TT, lipid profile, fasting blood glucose, sex hormone-binding globulin, liver function test, prostate-specific antigen (PSA) and adverse events. Results• The mean (SD) age of the participants was 53.4 (7.6) years.• A significant increase in serum TT (P < 0.001), PSA (P = 0.010), haematocrit (P < 0.001), haemoglobin (P < 0.001) and total bilirubin (P = 0.001) were seen in the treatment arm over the 48-week period.• Two men in the placebo arm and one man in the treatment arm developed myocardial infarction.• Common adverse events observed in the treatment arm included itching/swelling/pain at the site of injection, flushing and acne.• Overall, TU injections were well tolerated. Conclusions• TU significantly increases serum testosterone in men with TD. • PSA, haemoglobin and haematocrit were significantly elevated but were within clinically safe limits.• There was no significant adverse reaction that led to the cessation of treatment.

BackgroundMore than half of the general population does not attend screening for cardiovascular diseases (CVD) hence they are unaware of their risks. The objective of this study was to explore the views and experiences of the public in deciding to undergo health checks for CVD prevention.MethodsThis was a qualitative study utilising the constructivist grounded theory approach. A total of 31 individuals aged 30 years and above from the community were sampled purposively. Eight interviews and six focus groups were involved, using a semi-structured topic guide.ResultsA conceptual framework was developed to explain the public’s decision-making process on health check participation for CVD prevention. The intention to participate in health checks was influenced by the interplay between perceived relevance and the individual’s readiness to face the outcome of health checks. Health checks were deemed relevant if people perceived themselves to be at risk of CVD and there was an advantage in knowing their cardiovascular status. People were ready to face the outcome of health checks if they wanted to know the results and were prepared to deal with the subsequent management. The decision to participate in health checks was also influenced by external factors such as the views of significant others, and the accessibility and availability of resources including time and finances.ConclusionsThe intention to screen for CVD is motivated by two internal factors: the perceived relevance of the disease and readiness to face screening outcomes. Strategies targeting the internal decision-making process may prove to be key in improving the uptake of screening.

What ' s known on the subject? and What does the study add? Testosterone defi ciency syndrome can be treated with testosterone replacement in the form of injectable, transdermal, buccal and oral preparations. Long-acting i.m. testosterone undecanoate 1000 mg, which is given at 10 − 14 week intervals, has been shown to be adequate for sustaining normal testosterone levels in hypogonadal men.This study confi rms that long-acting i.m. testosterone undecanoate is effective in improving the health-related quality of life in men with testosterone defi ciency syndrome as assessed by the improvement in the Aging Male Symptoms scale. Testosterone treatment can be indicated in men who have poor health-related quality of life resulting from testosterone defi ciency syndrome. OBJECTIVE• To evaluate the effect of i.m. injection of testosterone undecanoate 1000 mg over 12 months on the Aging Male Symptom (AMS) scale scores in men with testosterone defi ciency syndrome (TDS). PATIENTS AND METHODS• A total of 120 men > 40 years old with TDS (total testosterone < 12 nmol/L and total AMS scores ≥ 27) were randomized into i.m. injection of either placebo or testosterone undecanoate 1000 mg.• In all, 56 and 58 participants from the active treatment and placebo groups, respectively completed the study.• An i.m. injection of either placebo or testosterone undecanoate 1000 mg was given at weeks 0, 6, 18, 30 and 48.• Self-administered AMS questionnaires were completed at weeks 0, week 18 and week 48. RESULTS• Improvement in the total AMS score was signifi cantly greater in the treatment group than in the placebo group (F: 4.576, P = 0.017) over the 48-week period.• The mean ( SD ) total AMS score was 38.46 (11.85) at baseline and 33.59 (1.69) at 48 weeks for the placebo group, and 41.73 (12.73) at baseline and 32.61 (9.67) at 48 weeks for the treatment group.• The mean change in the total AMS score was − 12.6% in the placebo group and − 21.9% in the treatment group.• The mean psychological and somatovegetative domain scores decreased signifi cantly more in the treatment group than in the placebo group ( − 2.8 vs − 1.2, P = 0.03; and − 3.2 vs − 1.8, P = 0.016).• The difference in change between the randomized groups for the sexual domain scores followed the same trend, though the difference was not signifi cant. CONCLUSION• Long-acting testosterone is effective in improving health-related quality of life as assessed by the AMS scale in men with TDS. KEYWORDStestosterone defi ciency , hypogonadism , testosterone undecanoate , injectable , long-acting , AMS scale Study Type -Therapy (RCT) Level of Evidence 1b