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ABSTRACT@#Presently there is a lack of health-related quality of life (HRQOL) measure and its corresponding utility values for oral cancer and oral potentially malignant disorders (OPMD). This limits patient-centered outcomes for cost-effectiveness evaluations. The study aimed to determine post-treatment HRQOL of patients and ascertained differences between OPMD, early and late-stage oral cancer. A cross-sectional survey was conducted among patients in oral maxillofacial specialist clinics in two public tertiary hospitals. Consented participants were required to complete the EQ-5D-5L questionnaire with the EQ Visual Analogue System (VAS). Kruskal-Wallis test was used to explore differences in values between stages. Multiple linear regression was used to explore factors that influenced the HRQOL. A total of 50 OPMD and 52 oral cancer patients were surveyed. The mean EQ-5D-5L health utility values was 0.842 (n = 50, SD = 0.139), 0.822 (n = 10, SD = 0.150) and 0.626 (n = 42, SD = 0.310) for OPMD, early- and late-stage cancer, respectively. The mean values of the EQ-5D-5L index and EQ-VAS scale showed significant differences between groups and between early- and late-stage cancer with good discriminative properties. Results of the multiple linear regression indicated that ethnicity, income, residency, diagnosis, and treatment modality were able to significantly account for 25% of EQ-5D-5L utility values, F(10,91) = 3.83, p < 0.001, R2 = 0.360. Indian ethnicity, rural location, income less than RM4,360, late-stage cancer, and multi-modal therapies were all predictors of poorer HRQOL. This study evidenced disease severity and treatment modality to greatly impact the HRQOL of patients, in addition to socio-demographic factors such as ethnicity and income.
Subject(s)
Quality of Life , Mouth NeoplasmsABSTRACT
@#Introduction: In understanding of the general public’s knowledge, attitude and practice (KAP) on the returning and disposal of unused medications is imperative towards the designing of better educational materials and policy development. The objectives of this study was to validate the Malay version of the Return and Disposal of Unused Medications (ReDiUM) questionnaire for use among Malaysian as well as to gain an understanding on these patterns of behaviour among Malaysians. Methods: The English version of the ReDiUM was translated into Malay language according to international guidelines. Content and face validity of the questionnaire was examined by experts. Subsequently, the questionnaire was pilot tested in 10 native speakers. Reliability was assessed using Cronbach’s alpha coefficients. The test-retest reliability was measured with Spearman’s Correlation Coefficient and Cohen’s κ coefficient. Public were recruited through convenient sampling for the study. Results: The study recruited 319 respondents. For test-retest reliability, all the correlation coefficient values were >0.5 indicating strong reliability (26 respondents). Except few items, most of the kappa coefficients were >0.61 indicating substantial to almost perfect agreement. Cronbach’s alpha of the KAP domains were 0.585, 0.770 and 0.759, respectively. The median knowledge score was only 50% with some negative attitudes and practices found. Conclusions: The translated questionnaire was valid and reliable for use in Malaysia with acceptable to strong internal consistency and most items with substantial to almost perfect agreement. The findings from the study provide supporting evidence for policy makers to develop interventions to help with reducing wastage and optimize healthcare expenditure.
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@#he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
Subject(s)
DementiaABSTRACT
As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.
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Prayers, spiritual healing, yoga, meditation, t’ai chi, qigong and support groups are classified as mind body complementary therapies (MBCTs). The study aimed to examine the prevalence of MBCTs use and the Health Related Quality of Life (HRQoL) in a group of Malaysian cancer patients. Methods: This crosssectional study was conducted on 184 cancer patients at the oncology clinic of Penang general hospital, Malaysia. MBCTs was assessed using a self- administered questionnaire while the HRQoL of the participants was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Among the complementary and alternative medicines (CAM) users, 75(40.7%) patients self-reported using MBCTs while having cancer. Majority of MBCTs users were female 60(80%, p=0.01), aged between 38 and 57 (58%), and were of Malay ethnicity (61%). Socio-demographic factors including age (r=0.15, p=0.03) and monthly house-hold income (r= -0.25, p<0.001) were significantly correlated with MBCTs use. Prayers for health reasons was the most frequently practised MBCTs modality, followed by spiritual practices 20(10.8%), meditation 7(5.9%), t’ai chi 7(3.8%), music therapy 4(2.1%), qigong 1(0.5%), hypnotherapy 1(0.5%), and reiki 1(0.5%). Recommendations from friends and family members 53(70%) were the most common reasons of MBCTs use followed by patient’s own will 22(29.3%). Health related Quality of Life (HRQoL) scores showed significant difference in all functional and symptoms scores among MBCTs users and non-users (p<0.05). Conclusion: The study helps to identify numerous MBCTs commonly practised by a group of Malaysian cancer patients. Prayers specifically for health reasons and spiritual practices were somewhat common among patients. Viewing MBCTs, not as alternative but to complement conventional cancer therapies may help to address cancer patients’ emotional and psychological needs.
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The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher [M.A.H.] using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women [P< 0.001]. Only 117 [32.3%] and 120 [33.0%] women were aware of the recommended breast self-examination [BSE] and clinical breast examination [CBE] guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer