Feasibility of supported self-management with a pictorial action plan to improve asthma control.

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .

Screening for type 2 diabetes and periodontitis patients (CODAPT-My©): a multidisciplinary care approach.

BACKGROUND: The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge of the oral health effects of diabetes. Likewise, dentists treating patients receiving diabetes treatment are rarely updated on the glycaemic status and as a result, the opportunity for shared management of these patients is missed. This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care for them to receive optimised care for glycaemic control. METHOD: A Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique where the experts comprised Family Medicine Specialists (5), Periodontists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services. RESULTS: The CODAPT© panel recommends referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to the dental healthcare team is outlined specifically. CONCLUSION: The CODAPT© care pathway has the potential to link dental clinics with primary care for diagnosis and/or optimised treatment of prediabetes/diabetes among patients receiving periodontitis treatment.

Posttraumatic Growth, Positive Psychology, Perceived Spousal Support, and Psychological Complications in Head and Neck Cancer: Evaluating Their Association in a Longitudinal Study.

Despite head and neck cancer (HNC) association with various negative impacts, collective evidence is accumulating regarding the positive impacts of positive psychology on cancer survivors. However, data on how positive psychology is related to the psychological complications of HNC across time are lacking. This longitudinal study examined the trends of positive psychology (e.g., posttraumatic growth [PTG], hope, and optimism), perceived spousal support, and psychological complications (e.g., depression, anxiety, and posttraumatic stress symptoms) and determined the association between them, psychological complications, and PTG across two timelines among a cohort of HNC patients. A total of 175 HNC respondents exhibited an increasing trend of positive psychology and perceived spousal support while reporting a decreasing trend of psychological complications between baseline and follow-up assessments. A greater degree of hope and perceived spousal support contributed to a higher degree of PTG across time. Conversely, a higher severity of anxiety symptoms was associated with a lower degree of PTG over time. Female gender had a moderating effect on the association between severity of anxiety symptoms and PTG, but did not moderate the association between hope, perceived spousal support and PTG. This study indicates the pivotal role of incorporating psychosocial interventions into the treatment regimen to enhance the degree of hope and perceived spousal support and reduce the severity of anxiety symptoms, which, in turn, will facilitate the development of PTG in HNC patients.

Sociocultural influences on asthma self-management in a multicultural society: A qualitative study amongst Malaysian adults.

BACKGROUND: Supported self-management improves asthma outcomes, but implementation requires adaptation to the local context. Barriers reported in Western cultures may not resonate in other cultural contexts. We explored the views, experiences and beliefs that influenced self-management among adults with asthma in multicultural Malaysia. METHODS: Adults with asthma were purposively recruited from an urban primary healthcare clinic for in-depth interviews. Audio-recordings were transcribed verbatim and analysed thematically. RESULTS: We interviewed 24 adults. Four themes emerged: (1) Participants believed in the 'hot and cold' concept of illness either as an inherent hot/cold body constitution or the ambient temperature. Hence, participants tried to 'neutralize' body constitution or to 'warm up' the cold temperature that was believed to trigger acute attacks. (2) Participants managed asthma based on past experiences and personal health beliefs as they lacked formal information about asthma and its treatment. (3) Poor communication and variable advice from healthcare practitioners on how to manage their asthma contributed to poor self-management skills. (4) Embarrassment about using inhalers in public and advice from family and friends resulted in a focus on nonpharmacological approaches to asthma self-management practice. CONCLUSIONS: Asthma self-management practices were learnt experientially and were strongly influenced by sociocultural beliefs and advice from family and friends. Effective self-management needs to be tailored to cultural norms, personalized to the individuals' preferences and clinical needs, adapted to their level of health literacy and underpinned by patient-practitioner partnerships. PATIENT AND PUBLIC CONTRIBUTIONS: Patients contributed to data. Members of the public were involved in the discussion of the results.

Lipid profile of regular kratom (Mitragyna speciosa Korth.) users in the community setting.

BACKGROUND AND AIM: Kratom, or Mitragyna speciosa Korth., is a tropical plant that has been reported to exhibit opioid-like effects. Although opioids have been demonstrated to alter the lipid profile of regular users, data on the lipid-altering effects of kratom are scarce. This study aimed to compare the fasting lipid profile of regular kratom users to that of healthy subjects who do not use kratom. It also determined the association between various characteristics of kratom users and the serum triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels of regular kratom users. METHODS: A total of 200 participants (n = 100 kratom users and n = 100 healthy subjects who do not use kratom) were recruited for this analytical cross-sectional study. Data on sociodemographic status, kratom use characteristics, cigarette smoking, physical activity, body mass index (BMI), fasting serum lipid profile, and liver function were collected from all participants. RESULTS: The liver parameters of the study participants were within normal range. The serum total cholesterol and LDL of kratom users were significantly lower than those of healthy subjects who do not use kratom. There were no significant differences in the serum triglyceride and HDL levels. However, higher average daily frequency of kratom use and increasing age were associated with increased serum total cholesterol among kratom users. Other kratom use characteristics such as age of first kratom intake, duration of kratom use, and quantity of daily kratom intake were not associated with increased serum triglyceride, total cholesterol, LDL, and HDL levels. CONCLUSIONS: Our findings suggest regular kratom consumption was not linked to elevated serum lipids, except when there is a higher frequency of daily kratom intake. However, the study was limited by the small sample size, and hence a more comprehensive study with larger sample size is warranted to confirm the findings.

Procalcitonin as an Early Laboratory Marker of Sepsis in Neonates: Variation in Diagnostic Performance and Discrimination Value.

BACKGROUND: As an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases. METHODS: This cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard. RESULTS: The study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h. CONCLUSIONS: Diagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.