Medical Journal of Malaysia最新文献

Introduction: Virtual ward (VW) is a hospital-led alternative to inpatient care enabled by technology where patients are looked after in their usual residence. Such a service may not be familiar to many. This survey aims to explore the views and acceptability of VW among hospitalised patients.

Materials and methods: This study was conducted among patients aged ≥18 years admitted to medical wards of a tertiary hospital in Malaysia. The survey questions were adapted from existing questionnaires and piloted before use. Participants were provided with a clinical vignette and description of a VW service before completing the questionnaire. It collated data on respondents' demographics, admission details, VW acceptability and their views on VW-related telehealth. The next of kin or main caregiver provided responses if the person was unable to participate.

Results: Responses were collected from 120 participants (95 patients, 25 caregivers), of which 108 respondents (90.0%) agreed to be managed by a VW service if such a service was available and able to meet their needs. Being at home, supported by family members, and the ability to maintain independence were the most common reasons cited for its acceptance. Among those unwilling, participants preferred to have the medical and nursing team close by. In terms of telehealth readiness, 95% of patients have internet access, and 97.5% possess the appropriate devices for video consultation. However, only 20% of patients have utilised online video consultations before to seek medical advice.

Conclusion: The majority of people surveyed were willing to accept a virtual ward service. The findings provide useful information towards the planning of virtual ward programmes in Malaysia.

Introduction: Pancreatic cystic lesions (PCLs) are becoming more frequently diagnosed due to the improved crosssectional imaging. Although some of them are harmless, others are malignant in nature, and proper diagnosis is very crucial. This systematised review evaluates the diagnostic effectiveness of nCLE in characterising pancreatic cysts in terms of sensitivity, specificity, diagnostic yield, as well as its strengths versus conventional diagnostic techniques.

Materials and methods: The systematic literature search was performed in PubMed, Scopus, and Google Scholar, including papers published between 2011 and March 2025. The inclusion criteria were randomised, prospective, and retrospective research in which nCLE diagnostic accuracy was reported in PCLs. Meta-analysis was conducted using PRISMA guidelines for data extraction, risk of bias assessment, and sensitivity analyses.

Results: The inclusion criteria were met in seventeen studies. As shown, nCLE was usually superior to cytology, cyst fluid carcinoembryonic antigen (CEA), and traditional EUS-FNA. Sensitivity was reported to be between 59-98% and specificity is between 82-100%. Of seven studies (n=216 cases) analysed by meta-analysis, the pooled sensitivity was 0.89 (fixed-effects) and 0.88 (random-effects), the heterogeneity was high (I2=74%). The Funnel plot analysis identified the possibility of publication bias and small-study effects. Robustness was ensured through sensitivity analysis, which was always pooled between 0.86-0.92.

Conclusion: It has been noted that nCLE improves diagnostic confidence, reduces indeterminate results, and has the potential to positively influence the economy and clinical management. The current evidence is strongly in favour of the clinical utility of nCLE, more large-scale, multicentred, and methodologically sound trials are necessary to determine the diagnostic performance of the technique, develop standardised protocols, and evaluate long-term effects on patient outcomes and healthcare systems.

Introduction: A group of conditions affecting the upper gastrointestinal tract, known as dyspepsia syndrome, includes epigastric pain, discomfort, bloating, frequent belching, nausea, and vomiting. According to the World Health Organization (WHO) data in 2015, dyspepsia was found to affect 13-40% of the population annually and is listed as one of the top 10 non-communicable diseases in Indonesia that can increase morbidity.

Materials and methods: This study aimed to investigate the relationship between dietary habits and the prevalence of dyspepsia syndrome among preclinical medical students at the Christian University of Indonesia in the 2023 class. The methodology employed was a descriptive-analytical study, utilizing a cross-sectional approach and a sequential sampling strategy, with 108 participants. This study employed univariate and bivariate analysis as its analytical methods.

Results: The findings of the univariate study revealed that most participants were 18 years old, and 76 women (70.4%) of the total respondents reported experiencing dyspepsia syndrome, accounting for 61.1% of the sample. In this study, bivariate analysis using the Chi-square test revealed a strong correlation (p-value < 0.001) between the incidence of dyspepsia syndrome and diet.

Conclusion: This study concluded that there is a relationship between diet and the development of dyspepsia syndrome.

Introduction: Hypertension remains a leading global health concern due to its high prevalence and serious health complications. Nowadays, home blood pressure monitoring (HBPM) has emerged as a valuable non-pharmacological intervention to control blood pressure (BP). Numerous studies have demonstrated the pattern of HBPM practice among hypertensive patients. However, information on optimal practice of HBPM instruction by the healthcare providers (HCPs) is still lacking. Therefore, the main objective of this study is to assess the prevalence of optimal practice of HBPM instruction methods by the HCPs to their hypertensive patients and factors associated with it.

Materials and methods: This is a cross-sectional study, conducted among HCPs with working experience of more than a year, from all four government primary health clinics in Putrajaya between March 2023 and September 2024. The validated Malay-version i-HBPM questionnaire, also known as "the practice of HBPM instruction methods for hypertensive patients" questionnaire was used in this study.

Results: A total of 285 HCPs were recruited in this study. The prevalence of optimal practice of HBPM instruction methods by the HCPs to their hypertensive patients was 14.4%. The most frequently reported barriers to HBPM recognition among HCPs were a lack of understanding of HBPM (28.8%), a lack of HBPM guidelines (17.2%) and the high cost of devices (16.5%). From the HCPs' thought and perspective, the top three most significant patient-related barriers were a lack of understanding of HBPM (42.1%), followed by high device cost (33.0%) and low education level (29.5%). Attending HBPM training was the only significant factor associated with the optimal practice of HBPM instruction methods given by HCPs to their patients (adjusted OR 3.48, 95.0% CI 1.29, 9.34, p = 0.013).

Conclusion: This study demonstrated a low prevalence of optimal practice of HBPM instruction methods provided by HCPs to their hypertensive patients despite high recognition and recommendation of HBPM among HCPs. HBPM training for HCPs is very crucial to improve their knowledge and consultation skills on HBPM.

Introduction: The global obesity epidemic threatens health systems worldwide and is associated with severe health complications such as cardiovascular disease, type 2 diabetes, and cancers, imposing substantial economic burdens. Globally, over 1.9 billion adults are classified as overweight, with 650 million identified as obese.

Materials and methods: A review was conducted using academic databases and authoritative reports from organizations such as the WHO and the Institute for Public Health. Studies published between 2002 and 2024 were selected based on methodological rigor and relevance to obesity in Malaysia.

Results: Malaysia has the highest obesity rate in Southeast Asia and has classified obesity as a chronic disease. Currently, 21.8% of Malaysian adults are affected by obesity - a fivefold increase from 4.4% in 1996 - with projections reaching 41% by 2040. Obesity-related healthcare costs consume 10-20% of Malaysia's national budget. Malaysia joined the Obesity Policy Engagement Network (OPEN) and implemented a model-of-care survey to gather healthcare professional insights and identify critical obesity management gaps. This initiative aimed to provide evidencebased recommendations to enhance patient outcomes and alleviate economic strain on the healthcare system. The Malaysian OPEN survey indicated that only one-third view obesity as a disease, resulting in underinvestment in necessary infrastructure and treatment options such as pharmacotherapy and bariatric surgery. These prevailing misconceptions among healthcare professionals and decision-makers hinder progress. A collaborative, multidisciplinary strategy supported by robust policies and evidence-based research is thus vital in managing obesity as a chronic disease.

Conclusion: Addressing obesity in Malaysia requires a collaborative, multidisciplinary approach that integrates lifestyle, behavioural, medical, and surgical strategies. Policy reform, stakeholder engagement, and evidencebased planning are essential to improve patient outcomes, reduce economic burdens, and ensure equitable access to care. A unified national effort is vital for sustainable and effective obesity management.

One of the most revolutionary breakthroughs in modern artificial intelligence research over the past decade has been the introduction of foundation models - deep learning models trained on extensive datasets that can be adapted to tackle a wide range of downstream tasks. The rise of foundation models has significantly accelerated the adoption of AI in healthcare where there is increasing digitalization, enabling the integration of medical imaging, clinical notes, and genomic data to provide a more holistic understanding of patient health and supporting personalized interventions. In this Editorial, we will explore how foundation models are catalysing insights in precision health and offer our perspective of how foundation models can be integrated into the Malaysian healthcare system. In addition, we will also highlight some of the issues concerning governance, ethical, regulatory and policy challenges of implementing these foundation models in the Malaysia.

Introduction: Patients with end-stage renal disease (ESRD) have compromised immune systems, possibly reducing their vaccine-induced antibody responses compared to the general population. COVID-19 remains a persistent threat, with the virus continuing to mutate into new variants. Similar to influenza, there is a possibility that COVID-19 could resurge significantly, underscoring the importance of understanding vaccine-induced immunity in vulnerable populations. This study aims to determine the immunogenicity of this group to the COVID-19 vaccine.

Materials and methods: Haemodialysis patients receiving the Pfizer-BioNTech mRNA vaccine were followed for at least 13 months. Blood samples were collected prior to every vaccine dose and at multiple intervals thereafter. Neutralising antibodies (nAb) against SARS-CoV-2 were measured. Patients voluntarily reported any COVID-19 infection.

Results: Between April 2021 and January 2023, 271 patients received at least one dose of the vaccine; 212 of these had at least one blood sample tested for nAb. Booster doses were given 26.2 weeks after the second dose. nAbs were detected in 16.8% of patients before vaccination. The nAb levels were higher than the non-convalescent patients after the first dose, but it was not statistically significant. Breakthrough infections were self-reported in 29.3% of patients. A significant association between breakthrough infections and history of COVID-19 infection cannot be established (p=0.188). There were 34 deaths (16.0%); 2 related to COVID-19. Younger age was associated with higher nAb reactivity post-first dose, but this difference diminished after the second dose.

Conclusion: Almost complete seropositivity (98.4%) was achieved after two doses of vaccine. Sustained antibody levels after the third dose suggest the value of a booster dose in protecting this vulnerable population. However, the occurrence of breakthrough infections highlights the need for continued monitoring, preventive measures, and further research to optimise vaccination strategies in haemodialysis patients.

Introduction: Acute poisoning is a frequent reason for emergency department (ED) visits, with varying patterns of presentation across different regions. This study examines the clinical characteristics, sociodemographic factors, and outcomes associated with acute chemical poisoning in a Malaysian population.

Materials and methods: This is a retrospective case note review of acute chemical poisoning presenting to the ED of a tertiary government hospital in Malaysia from 2016 to 2018. Data were collected on sociodemographic details, clinical presentations, and outcomes, with multiple logistic regression used to identify factors associated with its complications.

Results: A total of 260 cases were included, with 168 (64.6%) being intentional poisonings and 92 (35.4%) accidentals. The majority of patients were single (60.8%), male (58.5%), and of Indian ethnicity (57.3%). The most common agents were pesticides (42.2%). The overall complication rate was 14.2%, and the mortality rate was 4.6%. The most frequent complications were respiratory insufficiency (11.5%) and renal failure (6.5%). Factors significantly associated with complications included intentional poisoning (AOR 3.18, 95% CI 1.05-9.66, p=0.042), ethnicity (Chinese: AOR 12.85, 95% CI 1.40-118.35, p=0.024; other races: AOR 25.99, 95% CI 2.34-238.00, p=0.004), exposure during daytime hours (AOR 12.79, 95% CI 1.52-107.42, p=0.019), and a delay of 2-12 hours before ED visit (AOR 2.30, 95% CI 1.02-5.20, p=0.045).

Conclusion: Acute chemical poisoning is more common in single males with intentional exposures. Important factors associated with its complications include age, ethnicity, the time of exposure, and delayed presentation to the ED.

Introduction: Chest X-ray (CXR) remains one of the most commonly used diagnostic imaging tools in clinical practice. However, the accuracy and competency in reading and interpreting CXRs can vary significantly across different levels of medical practitioners, ranging from house officers to senior specialists. The purpose of this study was to assess competency in CXR interpretation among doctors at different stages of their medical careers.

Material and methods: This is a cross-sectional study conducted using CXRs, which were displayed digitally. A total of 305 participants were recruited, including house officers, medical officers, and registrars in specialty training. A standard set of ten radiographs was chosen, and the participants were required to interpret the CXR in multiple-choice format. Data analysis was performed via IBM SPSS Statistics software, version 25.

Results: Clinical history improved the ability to accurately interpret CXR, with the percentage of participants who accurately interpreted CXRs increasing from 21% of participants who achieved high scores without clinical history to 63.6% of participants who achieved high scores with clinical history. The participants' field of interest and confidence level when reporting a CXR without history were associated with higher accuracy (p<0.05) when interpreting a CXR. However, when the clinical history was given to the participant, only the confidence level of the participant affected the final score of the CXR. There is no significant difference in the ability of doctors to interpret CXR despite the difference in seniority in practice; moreover, undergraduate exposure does not play a significant role.

Conclusion: Structured teaching, continuous practice, feedback and integration into clinical decision-making are the keys that translate to greater competency in CXR interpretation. Future researches should emphasize on multicenter approach as it enhances the generalizability of findings to a broader national context.

Introduction: Hepatitis C virus (HCV) infection is prevalent among people who inject drugs globally and in Malaysia. Drug rehabilitation centres (PUSPEN) offer opportunities for intervention, but the feasibility of HCV care cascades in these settings requires evaluation. This study aims to evaluate the outcome of an integrated HCV screen-and-treat program implemented at PUSPEN Perlis, Malaysia.

Materials and methods: This retrospective cohort study analysed data from an HCV screen-and-treat program conducted between October 2022 and December 2023 at PUSPEN Perlis. The program involved initial screening with rapid antibody testing, confirmatory HCV RNA testing, APRIbased fibrosis assessment, and Direct-Acting Antiviral (DAA) treatment, with Sustained Virologic Response at 12 weeks post-treatment (SVR12) as the primary outcome.

Results: Screening of 461 participants during study period identified 62 (13.4%) as HCV antibody positive. Significant attrition occurred before confirmatory testing, with 34 (54.8%) undergoing HCV RNA tests, of whom 33 (97.0%) were positive. Treatment initiation was also limited, with 17 (51.5%) starting DAA therapy, primarily due to anticipated short rehabilitation stays. One participant transferred during therapy; the remaining 16 completed the 12-week regimen, all achieving SVR12 (100%) without reported adverse effects.

Conclusion: HCV screen-and-treat programs are feasible in Malaysian drug rehabilitation centres but face challenges in linkage to confirmatory testing and treatment initiation, largely due to limitations imposed by the duration of stay. While DAA therapy is highly effective when completed, strategies addressing diagnostic streamlining, potentially shorter regimens, and continuity of care post-release are crucial to optimise HCV elimination efforts in this vulnerable population.