Malaysian Family Physician最新文献

This case report delves into facilitating return to work (RTW) in a working-age stroke survivor. The patient was a 42-year-old Malay man who experienced multifocal lacunar infarctions in April 2022. He demonstrated substantial motor function recovery but presented with subtle cognitive deficits impacting various domains. The report outlines the diagnostic process of cognitive assessments and discusses the patient's medical history and stroke-related factors. The management plan encompassed a multidisciplinary approach in primary care, which involved incorporating cognitive rehabilitation, discussing barriers and exploring the perception of the ability to RTW. This case underscores the intricacies of mild cognitive impairment in working-age stroke survivors and emphasises the need for tailored interventions in primary care to optimise cognitive recovery and enhance the overall quality of life.

Achondroplasia, a genetic disorder causing limb shortening, is the most common form of disproportionate dwarfism. It can be diagnosed prenatally through sonographic findings and postnatally through clinical and radiological findings. Currently, an increasing number of affected foetuses are diagnosed antenatally since prenatal ultrasonography is routinely conducted in primary care settings. Herein, we present the case of a healthy 26-year-old primigravida who received a diagnosis of achondroplasia for her foetus during the late third trimester based on her prenatal ultrasonographic findings. Following birth, the diagnosis was confirmed by the baby's clinical and radiological findings, which showed shortening of the long bones. This case highlights the importance of recognising the soft markers of achondroplasia during routine third-trimester ultrasonography in primary care settings. Early diagnosis of achondroplasia is important to ensure timely referral to tertiary centres and adequate preparation of parents for the delivery of their baby.

Introduction: Acute otitis media is a common disease in children under the age of 5 years due to their primitive ear anatomy. One of its consequences is otitis media with effusion (OME), which is a condition wherein serous secretion accumulates in the middle ear due to Eustachian tube dysfunction. OME results in conductive hearing loss, impacting children's learning and development. This review aimed to identify discrepancies in clinical practice guidelines (CPGs) for managing OME in children across Asian and Western countries, focusing on updates to these guidelines.

Methods: A comparative review involving critical appraisal using the Appraisal of Guidelines for Research and Evaluation II tool was conducted. CPGs for managing ear effusion in children in Western and Asian countries published in the PubMed, Cochrane Library, Scopus and Science Direct databases were reviewed. Four CPGs from Western countries (Scotland, England, the United States of America and France) and three CPGs from Asian countries (Japan, Korea and Malaysia) were selected.

Results: There was a mild discrepancy regarding conducting surgery after 3 months, particularly myringotomy and adenoidectomy with or without grommets, between the Scottish CPG and other CPGs.

Conclusion: Asian CPGs for the management of OME share many similarities with Western CPGs. However, Asian CPGs tend to be stronger in most domains and levels of evidence. Japanese and American CPGs are up to date as of 2022 and 2016, respectively, while other CPGs are outdated for about 10 years.

Introduction: Non-orthopaedic-trained healthcare professionals face challenges in identifying postnatal clubfoot deformities due to the lack of suitable assessment tools, resulting in misdiagnosis. Therefore, this study aimed to develop and validate the Neonatal Clubfoot Screening Checklist (NCSC) to assist non-orthopaedic-trained healthcare professionals in postnatal clubfoot assessment.

Methods: The NCSC development involved five phases: conceptual understanding of deformity components, creation of pictorial representations, tool structure design, content and face validation, pilot study and field study. A cross-sectional prospective study was conducted in Sarawak General Hospital from January to June 2021. Non-orthopaedic-trained healthcare professionals were randomly assigned to two groups: one utilising the NCSC for newborn screening and another without it. Results were compared with assessments by the paediatric orthopaedic team. Kappa agreement tests and sensitivity and specificity analyses were performed to evaluate the tool's reliability and validity, respectively.

Results: The content and face validity were satisfactory. Six hundred twelve feet were screened using the NCSC, and 596 feet were checked without the tool. The kappa agreement tests showed strong concordance (kappa coefficient=0.725-1.000, P<0.001) between the non-orthopaedic-trained personnel and paediatric orthopaedic team for all NCSC items. The NCSC exhibited 100% sensitivity, specificity and positive and negative predictive values.

Conclusion: The NCSC is a reliable tool for postnatal clubfoot screening, offering high sensitivity and specificity. It facilitates accurate differentiation of true-positive congenital talipes equinovarus from other foot conditions, reducing misdiagnoses and unnecessary referrals. The NCSC is valuable in resource-constrained settings and for healthcare professionals lacking specialised orthopaedic training.

Introduction: There is limited understanding of the association of grandparenting with the wellbeing of older adults with chronic diseases. This study aimed to examine grandparenting practices and their association with physical and mental well-being among older adults.

Methods: The cross-sectional study was conducted at an outpatient clinic in a tertiary hospital in the Klang Valley, Malaysia. A total of 421 older patients with grandparenting experience were interviewed. The SF-12 Version 2.0 Health Survey was utilised to assess mental and physical wellbeing. Sociodemographic information, chronic disease care and grandparenting practices were evaluated to investigate any potential relationship with physical and mental well-being.

Results: Of the participants, 80% were aged 60-74 years; 62.5% were women; and 81.4% completed secondary education. More than half of the participants voluntarily took on the role of grandparenting. The participants showed an impaired physical function but a preserved mental wellbeing. Never missing regular medication due to grandparenting and taking up grandparenting based on the circumstances were related to mental health. However, no factor was significantly associated with physical well-being.

Conclusion: Two factors are linked to improved mental well-being. In contrast, there is no significant relationship found between a decline in physical health and grandparenting practices. Further research is needed to determine the causal relationship between physical health challenges and grandparenting practices.

Palliative care is a vital component of primary healthcare systems, especially in Asia, where the ageing population is expected to increase significantly in the coming years. Integrating palliative care into primary healthcare systems is a crucial strategy for achieving universal access to palliative care. It is necessary to take concurrent actions to achieve this integration, including integrating palliative care into public health policies, educating primary healthcare workers, establishing appropriate service structures and ensuring the availability of controlled medications. Healthcare professionals involved with primary care, often led by physicians, play a significant role in driving the implementation of primary palliative care in Asia, as evidenced by their involvement in community- and home-based palliative care in India and primary palliative care for patients with cancer in Indonesia. However, there are challenges associated with implementing these actions in each country. Therefore, it is crucial to examine the ongoing advocacy efforts, milestones, obstacles and strategies that shape this process in the Asian context.