1.Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review
Malaysian Family Physician 2014;9(2):18-25
This review highlights the high prevalence of antibiotic use for upper respiratory tract infections(URTIs) in a larger part of the Asia-Pacific region. Since URTIs are one of the common reasons for primary care consultations in this region, inappropriate use of antibiotic in both quantity and drug choice has greatly influenced the development of antibiotic resistance. Notwithstanding the
paucity of Asia-Pacific data on the above issues, the available information suggests urgent actions needed to be taken to promote judicious antibiotic use at the point-of-care through a multipronged approach targeting the patients/consumers (or parents), healthcare providers and health care systems.
Anti-Bacterial Agents
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Respiratory Tract Infections
2.Do statins adversely affect the HbA1c of diabetic patients?
Malaysian Family Physician 2017;12(1):39-40
This paper discusses the adverse effect of statins on the HbA1c levels of diabetic patients. Studies
have shown that statins may slightly worsen the HbA1c level. The effects vary depending on the type
of statins, the dosage and the duration of therapy. However, it has been confirmed that statin use
has benefits that outweigh its harms. Therefore, a diabetic patient should be given advice on the
need for appropriate lifestyle changes and the importance of continuing the statins.
3.White coat effect and white coat hypertension: one and the same?
Malaysian Family Physician 2008;3(3):158-161
White coat hypertension (WCHT) and white coat effect (WCE) are often thought to be of the same entity. They are in fact different conditions which carry distinctive definitions and prognostic significance. WCHT is diagnosed when office blood pressure (OBP) is ≥140/90 mmHg on at least 3 occasions, while the average daytime or 24-hour blood pressure is <135/85 mmHg. It is common with 15% prevalence in the general population and may account for over 30% of individuals in whom
hypertension is diagnosed. Although individuals with WCHT were reported to have a better cardiovascular (CV) prognosis when compared to those with sustained hypertension and masked hypertension; they were also shown to have a greater prevalence of target organ damage (TOD) and metabolic abnormalities than that of normotensive subjects. In contrast, WCE is defined as the transient elevation of OBP induced by the alerting response to a doctor or a nurse. WCE can occur in both
normotensive and hypertensive persons; and is not substantially influenced by reassurance and familiarisation. There is conflicting evidence with regards to prognostic significance of WCE, where most data indicated that it does not predict future
TOD, CV morbidity or mortality; with some studies showed otherwise. This case scenario aims to solve the diagnostic
perplexity with regards to WCHT and WCE, followed by an evidence-based commentary of how to best manage such
conditions.
4.Morbidity and process of care in urban Malaysian general practice: the impact of payment system.
Teng CL ; Aljunid SM ; Cheah M ; Leong KC ; Kwa SK
The Medical Journal of Malaysia 2003;58(3):365-374
BACKGROUND: The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. OBJECTIVES: We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. RESULTS: During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. CONCLUSION: This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.
*Family Practice
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*Financing, Personal
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Malaysia
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*Morbidity
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*Process Assessment (Health Care)
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*Urban Health Services