Health-Related Quality of Life among Patients with Oral Potentially Malignant Disorder and Oral Cancer in Malaysia

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.

A Clinical Audit and Impact of Interventions on Antibiotic Prescribing Practices at a Public Dental Primary Care Clinic

ABSTRACT@#Inappropriate antibiotic prescribing in dentistry has been widely reported but local studies are scarce. We aimed to evaluate antibiotic prescribing practices among dental officers in a public dental primary care clinic against current guidelines: specifically assessing the number, appropriateness, accuracy of prescriptions, type of antibiotics prescribed and repeated prescribing of the same type of antibiotics within a specific duration. A retrospective audit consisting of two cycles (1st cycle: July to September 2018, 2nd cycle: July to September 2019) was carried out by manually collecting relevant data of patients (aged 18 and above) who were prescribed antibiotics from carbon copies of prescription books. Between each cycle, various interventions such as education through a continuous professional development (CPD) session, presentation of preliminary findings and making guidelines more accessible to dental officers were implemented. When the 1st and 2nd cycles were compared, the number of antibiotic prescriptions issued reduced from 194 to 136 (–30.0%) whereas the percentage of appropriate prescriptions increased slightly by 4.1%. Inaccurate prescriptions in terms of dosage and duration decreased (–0.5% and –13.7%, respectively) whilst drug form and frequency of intake increased (+15.7% and +0.7%, respectively). Repeated prescribing of the same antibiotics by the same officer within a period of ≤6 weeks no longer occurred. Amoxicillin and metronidazole were most commonly prescribed in both cycles. Overall, the antibiotic prescribing practices did not closely adhere to current guidelines. However, clinical audit in conjunction with targeted interventions resulted in improvement in the antibiotic prescribing patterns. Thus, further intervention and re-audit is necessary.