Publications ; Ethics

Evidence-Based Medicine ; Primary Health Care

Chilaiditi’s sign describes the incidental radiographic finding of the bowel positioned between the right diaphragm and the liver. This is often misdiagnosed as pneumoperitoneum or free air under the diaphragm, which may lead to unnecessary investigations or surgical procedures. Here, we report two incidental chest radiograph findings of air under the diaphragm in patients who were being screened for pulmonary tuberculosis. This case series highlights the importance of awareness of the diagnosis of Chilaiditi’s sign to avoid unnecessary hospital referrals.

Background: Chronic low back pain (CLBP) is a common and often difficult to treat conditionin the primary care setting. Research involving in-depth exploration on the views and experiencesfaced by primary care doctors in managing patients with CLBP in Malaysia is limited.Objective: To explore the primary care practitioners’ views and experiences in managing patientswith CLBP.Study design: A qualitative approach was employed using focus group discussions (FGD) at anacademic primary care clinic in Kuala Lumpur, Malaysia. Twenty-three primary care doctorswere purposively selected. Data were collected through audio-recorded interviews, which weretranscribed verbatim and checked for accuracy. Data saturation was reached by the third FGD. Anadditional FGD was included to ensure completeness. A thematic approach using the one sheet ofpaper (OSOP) method was used to analyse the data.Results: Participants view managing patients with CLBP as challenging. This is mainly due to thedifficulty in balancing the doctors’ expectations with the patients’ perceived expectations duringconsultation. Barriers identified include lack of awareness and conflicting views regarding theusefulness of the local clinical practice guideline (CPG) in clinical practice. Other barriers includetime constraints and perceived lack of support from multidisciplinary teams in managing thesepatients.Conclusion: Managing patients with CLBP is still a challenge for Malaysian primary care doctors.Any intervention should target identified barriers to improve the management of patients with CLBP.

Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. The objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in diabetes patients aged 20 years or more in the primary care setting. Methods: This was a cross-sectional study involving the use of self-administered questionnaire conducted in eight primary care private and government clinics in Pulau Pinang and Melaka, Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of DAS. Prior permission was obtained from the patients and, clearance from ethical committee was obtained before the start of the study. Data analysis was done using SPSS statistical software. Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to be significantly associated with marital status and family history of DAS; anxiety was significantly associated with monthly household income, presence of co-morbidities and family history of DAS; and stress was significantly associated with occupation and family history of DAS. Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the general community. We recommend to routinely screen all patients with diabetes using the DASS-21 questionnaire because it is easy to perform and inexpensive.