Pathmawathi Subramanian

Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome.

Background: Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing. Aim: This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome (ACS). Methods: An interventional study was conducted at a tertiary teaching hospital in Malaysia. A total of 62 patients with ACS were equally randomised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge. The primary outcome was adherence to cardiac medications. Secondary outcomes were the heart functional status, and ACS-related hospital readmission and death rates. Results: There was a higher medication adherence level in the intervention group rather than the usual care group, (χ2 (2)=18.614, p<0.001). The risk of being low adherent among the control group was 4.09 times greater than the intervention group (relative risk =4.09, 95% confidence interval (CI) 1.82–9.18). A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders, (χ2 (1) = 16.957, p<0.001). Conclusion: An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period.

Breast Cancer Knowledge and Screening Behaviour among Women with a Positive Family History: A Cross Sectional Study

BACKGROUND Breast cancer is the commonest type of cancer among women, and in Malaysia 50-60% of the new cases are being detected at late stages. Do age, education level, income, ethnicity, relationship with breast cancer patients and knowledge of breast cancer risk factors influence breast screening practices? This study revealed interesting but significant differences. OBJECTIVES To assess the knowledge of breast cancer risk factors and early detection measures among women in a high risk group. MATERIALS AND METHODS A cross sectional survey of one hundred and thirty one women relatives of breast cancer patients was carried out. Participants were selected through purposive sampling, during hospital visits. A self-administered questionnaire was used for data collection. RESULTS The majority of the respondents (71%) had poor knowledge of the risk factors for breast cancer. Income, relationship with a patient and practise of breast cancer screening predicted performance of mammography, R2=0.467, F=12.568, p<0.0001. CONCLUSIONS The finding shows inadequate knowledge of breast cancer risk factors and poor cancer screening practise among women with family history of breast cancer. Poor knowledge and practise of breast screening are likely to lead to late stage presentation of breast cancer disease. Some important predictors of breast cancer screening behaviour among women with positive family history of breast cancer were identified. An understanding of the strengths and significance of the association between these factors and breast screening behaviour is vital for developing more targeted breast health promotion.

Perceived Susceptibility, and Cervical Cancer Screening Benefits and Barriers in Malaysian Women Visiting Outpatient Clinics

AIMS A main reason for increasing incidence of cervical cancer worldwide is the lack of regular cervical cancer screening. Coverage and uptake remain major challenges and it is crucial to determine the perceived susceptibility to cervical cancer, as well as the benefits of, and barriers to, cervical cancer screening among women. MATERIALS AND METHODS A cross-sectional survey was conducted among 369 women attending an outpatient centre in Malaysia and data were collected by administering a self-report questionnaire. RESULTS The majority of the participants (265, 71.8%) showed good level of perception of their susceptibility to cervical cancer. Almost all responded positively to four statements about the perceived benefits of cervical cancer screening (agree, 23.1% or strongly agree, 52.5%), whereas negative responses were received from most of the participants (agree, 29.9%or strongly agree, 14.6 %) about the eleven statements on perceived barriers. Significant associations were observed between age and perceived susceptibility(x2=9.030, p=0.029); between employment status (p<0.001) as well as ethnicity and perceived benefits (p<0.05 [P=0.003]); and between education and perceived barriers to cervical cancer screening (p<0.001). CONCLUSIONS Perceived susceptibility, including knowledge levels and personal risk assessment, should be emphasized through education and awareness campaigns to improve uptake of cervical cancer screening in Malaysia.

The effect of facilitated tucking on procedural pain control among premature babies

AIMS AND OBJECTIVES To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants. BACKGROUND Preterm neonates are exposed to a myriad of invasive, often painful, procedures throughout their stay in the neonatal intensive care unit. A growing volume of evidence shows that pain in preterm infants has both short- and long-term deleterious effects. It is within the power and ethical responsibility of neonatal nurses to help premature babies cope with procedural pain. DESIGN A quasi-experimental study with two groups: control and treatment group. METHODS A study was conducted on a cohort of preterm infants (n = 42), divided into control (n = 21) and treatment (n = 21) groups, to determine the effect of facilitated tucking on pain relief during venepuncture on preterm infants in the neonatal intensive care unit. The severity of pain was measured using the Premature Infant Pain Profile score. The primary outcome measure was reduction in the Premature Infant Pain Profile scores. RESULTS The Premature Infant Pain Profile score for the treatment group was significantly lower (M = 6·62, SD 2·598) than for the control group (6·62 ± 2·60 vs. 8·52 ± 2·99, respectively, t = -2·202, p < 0·05). CONCLUSIONS Facilitated tucking reduced the Premature Infant Pain Profile scores in preterm infants. RELEVANCE TO CLINICAL PRACTICE The findings of this study suggest that facilitated tucking is able to alleviate pain; therefore, nurses must be able to carry out facilitated tucking when necessary.

Cognitive assessment tools in Asia: a systematic review

BACKGROUND The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia. METHODS Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained. RESULTS Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derived de novo from Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17-29/30) and MoCA (21-26/30), with 13/19 (68%) of studies reporting educational bias. CONCLUSIONS Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.

Symptom Experiences and Coping Strategies among Multi- ethnic Solid Tumor Patients Undergoing Chemotherapy in Malaysia

BACKGROUND This study was performed to assess patient symptoms prevalence, frequency and severity, as well as distress and coping strategies used, and to identify the relationships between coping strategies and psychological and physical symptoms distress and demographic data of cancer patients. This cross-sectional descriptive study involved a total of 268 cancer patients with various types of cancer and chemotherapy identified in the oncology unit of an urban tertiary hospital. MATERIALS AND METHODS Data were collected using questionnaires (demographic questionnaire, Medical characteristics, Memorial Symptom Assessment Scale (MSAS) and Brief COPE scales and analyzed for demographic, and disease-related variable effects on symptom prevalence, severity, distress and coping strategies. RESULTS Symptom prevalence was relatively high and ranged from 14.9% for swelling of arms and legs to 88.1% for lack of energy. This latter was the highest rated symptom in the study. The level of distress was found to be low in three domains. Problem-focused coping strategies were found to be more commonly employed compared to emotion-focused strategies, demonstrating significant associations with sex, age group, educational levels and race. However, there was a positive correlation between emotion-focused strategies and physical and psychological distress, indicating that patients would choose emotion-focused strategies when symptom distress increased. CONCLUSIONS These findings demonstrate that high symptom prevalence rates and coping strategies used render an improvement in current nursing management. Therefore development of symptoms management groups, encouraging the use of self-care diaries and enhancing the quality of psycho- oncology services provided are to be recommended.

Life satisfaction and strain among informal caregivers of patients with traumatic brain injury in Malaysia.

Abstract Purpose: This study aims to determine the life satisfaction and strain on informal caregivers when caring for traumatic brain injury (TBI) patients and to examine the factors predicting the level of strain among the informal caregivers. Method: A cross-sectional survey on a purposive sampling was performed in a single centre in Malaysia recruiting caregivers of patients with TBI. Life Satisfaction Questionnaire-9 and Caregiver Strain Index questionnaires were used to ascertain the life satisfaction and strain of caregivers respectively. Relationship between life satisfaction and strain was analysed, together with factors significantly associated with strain. Results: A total of 141 caregivers (77.3% women, average age of 46.1 years ±12.8 and mean duration of caregiving of 24.8 months ± 14.3) were included in the analysis. Most caregivers (75%) were satisfied with their lives but more than half claimed to have strain (57%). There was a significant relationship between life satisfaction and strain among the caregivers (p < 0.001). From a multiple linear regression analysis, a caregiver’s monthly income of less than RM3000 (OR 6.48, 95% CI 1.48–28.40, p = 0.04), presence of patient’s neurobehavioural disturbances (OR 4.48, 95% CI 1.60–12.55, p = 0.004) and cognitive dysfunctions (OR 31.72, 95% CI 10.27–97.96, p < 0.001) were significant predictors of caregiver’s strain. Conclusion: Caregivers with lower monthly income and caring for TBI patients with cognitive and neurobehavioural disturbances are at higher risk of developing strain. Rehabilitation interventions post-discharge should aim at supporting the caregivers at risk. Implications for Rehabilitation Informal caregivers of patients with traumatic brain injury who are not satisfied with their lives are most likely experiencing strain. Caregivers in Malaysia who are at high risk of experiencing strain are those with lower monthly income and care for patients with significant cognitive and neurobehavioural disturbances. Efforts to reduce strain in caregivers at risk should be included in the post-discharge rehabilitation programme in Malaysia.

QUALITY OF END-OF-LIFE CARE

Background Critical care units (ICU) have been designed to provide highly skilled, lifesaving care for patients with acute illnesses or injuries. The mortality rate in the ICU still remains as a high rate comparing to the general word (Steinhauser et al., 2002). Having a good quality of end of life care (EOLC) is a common wish for patients who dying in the ICU. Quality of EOLC is the most popular measure to evaluate the quality of care provided to critically ill patients in the critical care units. Aim This paper aimed to systematically review original studies of quality of EOLC and appraise their quality. Method Only the original Studies that concerned on the quality of EOLC were included. Words like quality of EOLC, quality of dying and death were used to search in Midline and Ovid online data bases. Result Forty-nine studies met the selection criteria. These 31 quantitative, 16 qualitative and 2 mixed method studies identified different level of satisfaction to the quality of EOLC. Discussion The quality of EOLC still need to improve and barriers such as communication, lack of education and experiences, pain management, high expectations of families and environmental circumstances stile hindered the quality of EOLC. Conclusion different studies were conducted using different measures and methods to understand the quality of EOLC; however, further studies to identify the best strategies to improve EOLC are needed.

How Can We Best Screen for Cognitive Impairment in Malaysia? A Pilot of the IDEA Cognitive Screen and Picture-Based Memory Impairment Scale and Comparison of Criterion Validity with the Mini Mental State Examination

ABSTRACT Objectives: To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE). Methods: The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference. Results: The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5–83.0) years and 11.0 median years of education (IQR, 9.0–13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased. Conclusion: The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties. Clinical Implications: Study provides alternative screening tools for dementia for both non-specialists and specialists.

Perceptions of healthcare professionals on the usage of percutaneous endoscopic gastrostomy in a teaching hospital from a middle-income South East Asian country

ObjectiveTo explore the perceptions of healthcare professionals’ (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.DesignSemi-structured, qualitative interviews.SettingsA teaching hospital in Kuala Lumpur, Malaysia.ParticipantsA total of 17 healthcare professionals aged 23-43 years, 82% women.ResultsThematic analysis revealed five themes that represent HCPs’ perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.ConclusionThe rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.