Insulin oedema is a rare condition that may occur after the initiation or rapid intensification of insulin therapy in patients with long-standing hyperglycaemia, commonly with type 1 diabetes mellitus (DM). We reported a case of insulin oedema in a patient with type 2 DM who presented with swelling of the extremities and weight gain of 3 kg 1 week after insulin initiation. A course of furosemide was administered, but no significant immediate improvement was observed; however, the lower limb swelling resolved spontaneously after 3 months of follow-up. The patient also achieved adequate diabetic control with insulin, as shown by the reduction of her HbA1c from 10.7% to 6.9% over 6 months. Insulin oedema is a diagnosis of exclusion after ruling out other differential diagnoses, such as cardiac, renal, or liver failure. Although insulin oedema carries with it a good prognosis, physicians should be aware of the condition to avoid misdiagnosis.
Insulin ; Edema ; Diabetes Mellitus, Type 2

Cough is one of the most common complaints seen at the outpatient primary health clinic. While the most common aetiologies of chronic cough are asthma, chronic obstructive pulmonary disease, postnasal drip, gastroesophageal reflux disease, drug-induced, and tuberculosis, we often overlook that chronic cough, especially in a young female, can be the initial presenting complaint of an autoimmune disease. In this case report, we present a case of 35-year-old woman with no known prior medical illness who presented with chronic cough for 1 year with no other symptoms initially; but later in the disease course, the patient complained of multiple, symmetrical small joint pain, which led us to the diagnosis of seronegative rheumatoid arthritis.
Lung Diseases, Interstitial ; Chronic Cough

Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients.

Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.

Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.

Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition.

Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Introduction: Elderly population is at high-risk to suffer from malnutrition and nutritional inadequacy. The use of nutrition resource kit which provides nutritional guidance could be helpful to improve their dietary intake. There is no study performed previously on the type of nutrition resource kit that can be used to overcome and prevent malnutrition among Malaysian elderly. Therefore, this study aimed to identify the types of nutrition resource kit needed by community living elderly in Malaysian health clinic setting. Methods: Qualitative study was conducted to explore the types of nutrition resource kit needed by community living elderly in health clinics. Recruitment for in-depth individual interview targeted elderly aged ≥60 years old who met the inclusion and exclusion criteria and received primary healthcare services in four health clinics in Kuantan, Pahang. Interview questions addressed the knowledge on existing nutrition educational materials, preference for types of nutrition resource kit and opinion on technology-based materials. Data were audiotaped, transcribed verbatim and thematically analyzed using NVivo software version 12. Results: 21 participants involved in this study (mean age=67.24 ±6.98 years). Five key themes identified from the data: provision of nutrition resource kit; preference for printed version; eye-friendly; facilitate understanding with diagram; and support for technology-based materials. This study also found that majority of elderly preferred for A5-sized booklet for nutrition resource kit. Conclusion: Future development of nutrition resource kit tailored to the need of elderly is needed to deliver nutritional guidance effectively and served as an important reference for them to overcome malnutrition.

Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.