1.A red and swollen nose
Mohamed Syarif Mohamed Yassin ; Mohamad Zikri Mohamad Isa ; Noorhida Baharudin
Malaysian Family Physician 2020;15(1):61-63
TEST YOUR KNOWLEDGE
2.Pleuritic chest pain and fever: An unusual presentation of aortic dissection
Mohamed Syarif Mohamed Yassin ; Noorhida Baharudin ; Anis Safura Ramli ; Hilwati Hashim
Malaysian Family Physician 2019;14(1):47-52
It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not
always present. This case describes an atypical presentation of aortic dissection, in which the patient
walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein.
Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were
absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for
aortic dissection in the absence of classic features. The case is discussed with reference to the literature
on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination
of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this
frequently lethal condition.
3.A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic
Mohamed Syarif Mohamed Yassin ; Jazlan Jamaluddin ; Siti Nuradliah Jamil ; Mohd Azzahi Mohamed Kamel ; Mohamad Ya&rsquo ; akob Yusof
Malaysian Family Physician 2021;16(3):68-76
Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic.
Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies.
Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors.
Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.
4.Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care
Anis Safura Ramli ; Nur Hidayah Bahrom ; Mohamad Rodi Isa ; Noorhida Baharudin ; Siti Fatimah Badlishah Sham ; Mohamed Syarif Mohamed Yassin ; Hasidah Abdul Hamid
Malaysian Family Physician 2020;15(3):22-34
Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely
translated, and tested instruments worldwide in measuring patient activation levels in self-management.
This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients
with Metabolic Syndrome (MetS) attending a primary care clinic.Methods: This work is a cross-sectional validation study among patients with MetS attending a
university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process
and field testing. Psychometric properties were examined using principal component analysis (PCA)
with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest
reliability analyses.
Results: The content of the PAM-13 Malay version and the original version were conceptually
equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined
version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer–
Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two
factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and
Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items
representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of
13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation
coefficient was 0.45.
Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This
questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.
5.Gender disparity in the prescription of secondary prevention medications in a Malaysian primary care clinic
Noorhida Baharudin ; Ahmad Muslim Ahmad Roslan ; Mohamed Syarif Mohamed Yassin ; Anis Safura Ramli ; Aiza Nur Izdihar Zainal Abidin ; Nurul Hidayatullaila Sahar ; Nor Shazatul Salwana Din ; Izyana Syazlin Ibrahim ; Siti Nur Hidayah Abd Rahim ; Nur Athirah Rosli
Malaysian Family Physician 2021;16(2):37-44
Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it.
Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs.
Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370).
Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.