Displaying publications 61 - 80 of 127 in total

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  1. Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence
    Ramadas A, Quek KF, Chan CK, Oldenburg B
    Int J Med Inform, 2011 Jun;80(6):389-405.
    PMID: 21481632 DOI: 10.1016/j.ijmedinf.2011.02.002
    Introduction: The Internet has emerged as a potentially effective medium for information exchange. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus.
    Method: Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed.
    Results: Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well.
    Conclusion: The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.
    Matched MeSH terms: Evidence-Based Medicine
  2. Fulltext Knowledge, Attitude, and Practice of Evidence-Based Medicine among Emergency Doctors in Kelantan, Malaysia
    Ahmad Ghaus MG, Tuan Kamauzaman TH, Norhayati MN
    Int J Environ Res Public Health, 2021 10 27;18(21).
    PMID: 34769813 DOI: 10.3390/ijerph182111297
    This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.
    Matched MeSH terms: Evidence-Based Medicine
  3. Fulltext The product of outcome-based undergraduate medical education: competencies and readiness for internship
    Lai NM, Ramesh JC
    Singapore Med J, 2006 Dec;47(12):1053-62.
    PMID: 17139402
    INTRODUCTION: Outcome-based curriculum is adopted at the International Medical University (IMU), Malaysia, where specific learning objectives are laid out progressively under eight major outcomes. We present an outcome-guided, self-reported competency profile of our undergraduate students near the end of their training, focusing on elements that are considered most immediately relevant for their internship.
    METHODS: Anonymous surveys were conducted on two cohorts of medical students in their final semester at IMU. The surveys covered a range of competencies, including practical skills, ward routines, generic attributes and evidence-based medicine, grouped under the exit outcomes as defined by the university.
    RESULTS: A total of 92 students were assessed. In general, the students were confident of their ability on common practical skills and ward routines. They were comfortable with the level of professionalism and personal attributes required for internship, with the prospect of handling unexpected additional tasks and working away from home perceived as the main difficulties. Most students referred to at least three sources of clinical information to answer their clinical queries. However, they referred more to single journals than databases or collections. The majority could critically appraise journal articles to a variable extent, but nearly half took 30 minutes or longer to trace an abstract of interest.
    CONCLUSION: This report demonstrates the strength of outcome-based curriculum in its ability to produce competent students that are well prepared for their internship. Assessing students using this educational approach provides a clear picture of their strengths and weaknesses, and identifies stages in their training where additional inputs are required.
    Matched MeSH terms: Evidence-Based Medicine
  4. The 2nd International Conference on East-West Perspectives on Functional Foods: Science, Innovations and Claims
    Florentino RF
    Asia Pac J Clin Nutr, 2008;17(3):540-3.
    PMID: 18818176
    The 2nd International Conference on East-West Perspective on Functional Foods held in Kuala Lumpur, Malaysia, on November, 2007, discussed the current work on some traditional Asian foods and new technologies that offer both challenges and opportunities for functional foods. The highlight of the conference was on the current regulatory status of nutrition and health claims related to functional foods and the experiences in some countries on the substantiation of claims. Attention was also given to strategies for effective communication of functional foods to consumers. The conference concluded with recommendations to strengthen R and D efforts and harmonization of protocols and methodologies on functional foods within the region.
    Matched MeSH terms: Evidence-Based Medicine
  5. Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited
    Treuer T, Liu CY, Salazar G, Kongsakon R, Jia F, Habil H, et al.
    Asia Pac Psychiatry, 2013 Dec;5(4):219-30.
    PMID: 23857712 DOI: 10.1111/appy.12090
    Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.
    Matched MeSH terms: Evidence-Based Medicine*
  6. Fulltext Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan
    Thatte U, Hussain S, de Rosas-Valera M, Malik MA
    Value Health, 2009 Nov-Dec;12 Suppl 3:S18-25.
    PMID: 20586975 DOI: 10.1111/j.1524-4733.2009.00622.x
    This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices.
    Matched MeSH terms: Evidence-Based Medicine/economics*
  7. A systematic review of interventions by healthcare professionals on community-dwelling postmenopausal women with osteoporosis
    Lai P, Chua SS, Chan SP
    Osteoporos Int, 2010 Oct;21(10):1637-56.
    PMID: 20379700 DOI: 10.1007/s00198-010-1199-0
    A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women. Evidence available indicates that such interventions are effective in improving the quality of life, medication compliance, and calcium intake, but effect on other outcomes is less conclusive.

    INTRODUCTION: The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women.

    METHODS: Randomized controlled trials (RCTs) published in English between year 1990 and 2009 were identified. Types of patient outcome used as assessment included quality of life (QOL), bone mineral density (BMD), medication compliance and persistence, knowledge level, and lifestyle modification.

    RESULTS: Twenty four RCTs met the inclusion criteria. Seven studies assessed interventions by physiotherapists, six by physicians, seven by nurses, three by multi-disciplinary teams and one by dietitians. Variability in the types and intensity of interventions made comparison between each study difficult. Collectively, these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD, medication persistence, knowledge, and other lifestyle modifications were less conclusive.

    CONCLUSIONS: From this review, it was found that some outcome measures of such non-drug interventions still required further studies. Future studies should use validated instruments to assess the outcomes, with focus on common definitions of interventions and outcome measures, more intensive one-to-one interventions, appropriate control groups, adequate randomization procedures, and also provide information on effect size.
    Matched MeSH terms: Evidence-Based Medicine/methods
  8. Fulltext Information-seeking practices of senior medical students: the impact of an evidence-based medicine training programme
    Lai NM, Nalliah S
    Educ Health (Abingdon), 2010 Apr;23(1):151.
    PMID: 20589599
    CONTEXT: The practice of Evidence-based Medicine (EBM) involves physicians regularly accessing and appraising clinical information. Few prior studies have assessed the information-seeking behaviours of medical undergraduates. At the International Medical University (IMU), Malaysia, senior medical students receive clinically-integrated EBM training to facilitate their future practice of EBM.
    OBJECTIVES: We assessed whether EBM training in the final six months of medical training changes our students' information-seeking practices and their confidence in understanding and appraising clinical evidence.
    METHODS: Between September 2005 and February 2006, self-administered questionnaires were distributed to 65 senior medical students at the beginning and again at the end of their clerkship training during which there was a clinically-integrated EBM curriculum. The questionnaires covered the topics of their preferred sources of clinical information, online search frequencies, estimated time to retrieve an abstract, and their understanding and confidence in their critical appraisal skills.
    FINDINGS: Sixty-four (98%) students completed the initial survey and 63 (97%) completed the follow-up survey. The majority indicated that they preferred to first consult another individual (colleagues, lecturers, hospital staff) for their clinical queries (60.9% in the initial survey and 61.9% in the follow-up survey), with no change in their overall preference following the EBM curriculum six months later (p=0.144). There were significant increases in search activities following the curriculum, for example, students who searched PubMed or Medline for more than three times per week increased from 9.7% to 31.7% (p < 0.001). Students reported that they more often accessed single journals than databases. Despite significant improvements in students' reported understanding of journals and their confidence in critical appraisal (p < 0.001), there was no improvement in reported search speed, with 48.4% in the initial survey and 49.2% in the follow-up survey reporting to take 30 minutes or less to trace an abstract of interest (p=0.979).
    CONCLUSIONS: Our EBM training, offered within a supportive curriculum, increased our students' confidence and activity related to EBM, but failed to change students' reported information-seeking behaviours. Other factors influencing medical students' information-seeking practice need to be explored.
    Matched MeSH terms: Evidence-Based Medicine/organization & administration*
  9. Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia
    Gray L, Harding S, Reid A
    Eur J Public Health, 2007 Dec;17(6):550-4.
    PMID: 17353202
    BACKGROUND: Very little is known about how acculturation affects health in different societal settings. Using duration of residence, this study investigates acculturation and circulatory disease mortality among migrants in Australia.

    METHODS: Data from death records, 1998-2002, and from 2001 Census data were extracted for seven migrant groups [New Zealand; United Kingdom (UK)/Ireland; Germany; Greece; Italy; China/Singapore/Malaysia/Vietnam (East Asia); and India/Sri Lanka (South Asia)] aged 45-64 years. Poisson regression models were fitted to estimate the duration of residence effect (categorized in 5-year bands and also as having arrived 2-16, 17-31 and 32 years ago or more), adjusted for sex, 5-year age group and year of death, then additionally for occupational class and marital status (SES) on relative risks (RR) of CVD mortality.

    RESULTS: Compared with the Australia-born population, CVD mortality was generally lower in each migrant group. Decreasing mortality with increasing duration of residence was observed for migrants from New Zealand (RR 0.95, 95% Confidence Interval 0.92-0.98, P<0.01, per 5-year increase), Greece (0.90, 0.86-0.94, P<0.01), Italy (0.94, 0.91-0.97, P<0.01) and South Asia (0.95, 0.91-0.99, P<0.01), mainly in older age groups. Trends remained after SES adjustment and also when broader categories of duration of residence were used. CVD mortality among migrants from the UK/Ireland appeared to converge towards those of the Australian-born.

    CONCLUSIONS: These results show divergence in CVD mortality compared with the Australian rate for New Zealanders, Greeks, Italians and South Asians. Sustained cardio-protective behavioural practices in the Australian setting is a potential explanation.

    Matched MeSH terms: Evidence-Based Medicine*
  10. Fulltext Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study
    Hisham R, Ng CJ, Liew SM, Hamzah N, Ho GJ
    BMJ Open, 2016 Mar 09;6(3):e010565.
    PMID: 26962037 DOI: 10.1136/bmjopen-2015-010565
    OBJECTIVE: To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors' views and experiences.
    RESEARCH DESIGN: The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach.
    PARTICIPANTS: 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings.
    SETTING: The study was conducted across three primary care settings-an academic primary care practice, private and public health clinics in Klang Valley, Malaysia.
    RESULTS: The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors' daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors' practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience.
    CONCLUSIONS: Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace 'EBM culture' had an important influence on the doctors' behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care.
    Study site: klinik kesihatan, general practice clinics, Klang Valley, Malaysia
    Matched MeSH terms: Evidence-Based Medicine/standards*
  11. Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management
    Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.
    J Gastroenterol Hepatol, 2016 Sep;31(9):1555-65.
    PMID: 27042957 DOI: 10.1111/jgh.13398
    Walled-off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.
    Matched MeSH terms: Evidence-Based Medicine/methods
  12. Health-promoting effects of red palm oil: evidence from animal and human studies
    Loganathan R, Subramaniam KM, Radhakrishnan AK, Choo YM, Teng KT
    Nutr Rev, 2017 Feb 01;75(2):98-113.
    PMID: 28158744 DOI: 10.1093/nutrit/nuw054
    The fruit of the oil palm tree (Elaeis guineesis) is the source of antioxidant-rich red palm oil. Red palm oil is a rich source of phytonutrients such as tocotrienols, tocopherols, carotenoids, phytosterols, squalene, and coenzyme Q10, all of which exhibit nutritional properties and oxidative stability. Mutagenic, nutritional, and toxicological studies have shown that red palm oil contains highly bioavailable β-carotene and vitamin A and is reasonably stable to heat without any adverse effects. This review provides a comprehensive overview of the nutritional properties of red palm oil. The possible antiatherogenic, antihemorrhagic, antihypertensive, anticancer, and anti-infective properties of red palm oil are examined. Moreover, evidence supporting the potential effectiveness of red palm oil to overcome vitamin A deficiency in children and pregnant women, to improve ocular complications of vitamin A deficiency, to protect against ischemic heart disease, to promote normal reproduction in males and females, to aid in the management of diabetes, to ameliorate the adverse effects of chemotherapy, and to aid in managing hypobaric conditions is presented.
    Matched MeSH terms: Evidence-Based Medicine*
  13. 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis
    Lau CS, Chia F, Dans L, Harrison A, Hsieh TY, Jain R, et al.
    Int J Rheum Dis, 2019 Mar;22(3):357-375.
    PMID: 30809944 DOI: 10.1111/1756-185X.13513
    AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice.

    MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique.

    RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery.

    CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.

    Matched MeSH terms: Evidence-Based Medicine/standards
  14. Fulltext Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia
    Martis R, Ho JJ, Crowther CA, SEA-ORCHID Study Group
    BMC Pregnancy Childbirth, 2008;8:34.
    PMID: 18680603 DOI: 10.1186/1471-2393-8-34
    Evidence-based practice (EBP) can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia.
    Matched MeSH terms: Evidence-Based Medicine*
  15. Fulltext Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol
    Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, et al.
    BMC Med Res Methodol, 2007;7:43.
    PMID: 17892586
    Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?
    Matched MeSH terms: Evidence-Based Medicine*
  16. Fulltext Current trends in the management of chronic obstructive pulmonary disease
    Liam CK
    Med J Malaysia, 2000 Jun;55(2):285-92; quiz 293.
    PMID: 19839165
    Matched MeSH terms: Evidence-Based Medicine*
  17. Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine
    Lian PC, Marnoch G
    J Manag Med, 1999;13(2-3):178-89.
    PMID: 10747449
    This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelines-based medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit--less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings.
    Matched MeSH terms: Evidence-Based Medicine/statistics & numerical data*
  18. Fulltext Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance
    Loh LC, Ong HT, Quah SH
    Ann Acad Med Singap, 2007 Apr;36(4):281-4.
    PMID: 17483859
    INTRODUCTION: Medical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

    MATERIALS AND METHODS: To study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

    RESULTS: Of the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

    CONCLUSION: Our findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.
    Matched MeSH terms: Evidence-Based Medicine/education*
  19. Fulltext Investigation of comparative effectiveness research in Asia, Europe, and North America
    Patel I, Rarus R, Tan X, Lee EK, Guy J, Ahmad A, et al.
    Indian J Pharmacol, 2015;47(6):585-93.
    PMID: 26729947 DOI: 10.4103/0253-7613.169592
    Comparative effectiveness research (CER) is an important branch of pharmacoeconomics that systematically studies and evaluates the cost-effectiveness of medical interventions. CER plays instrumental roles in guiding government public health policy programs and insurance. Countries throughout the world use different methods of CER to help make medical decisions based on providing optimal therapy at a reduced cost. Expenses to the healthcare system continue to rise, and CER is one-way in which expenses could be curbed in the future by applying cost-effectiveness evidence to clinical decisions. China, India, South Korea, and the United Kingdom are of essential focus because these country's economies and health care expenses continue to expand. The structures and use of CER are diverse throughout these countries, and each is of prime importance. By conducting this thorough comparison of CER in different nations, strategies and organizational setups from different countries can be applied to help guide public health and medical decision-making in order to continue to expand the establishment and role of CER programs. The patient-centered medical home has been created to help reduce costs in the primary care sector and to help improve the effectiveness of therapy. Barriers to CER are also important as many stakeholders need to be able to work together to provide the best CER evidence. The advancement of CER in multiple countries throughout the world provides a possible way of reducing costs to the healthcare system in an age of expanding expenses.
    Matched MeSH terms: Evidence-Based Medicine*
  20. Fulltext A review of breast cancer research in Malaysia
    Yip CH, Bhoo Pathy N, Teo SH
    Med J Malaysia, 2014 Aug;69 Suppl A:8-22.
    PMID: 25417947 MyJurnal
    Four hundred and nineteen articles related to breast cancer were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred and fifty four articles were selected and reviewed on the basis of clinical relevance and future research implications. Overall, Malaysian women have poor survival from breast cancer and it is estimated that half of the deaths due to breast cancer could be prevented. Five-year survival in Malaysia was low and varies among different institutions even within the same disease stage, suggesting an inequity of access to optimal treatment or a lack of compliance to optimal treatment. Malaysian women have poor knowledge of the risk factors, symptoms and methods for early detection of breast cancer, leading to late presentation. Moreover, Malaysian women experience cancer fatalism, belief in alternative medicine, and lack of autonomy in decision making resulting in delays in seeking or avoidance of evidence-based medicine. There are ethnic differences in estrogen receptor status, HER2 overexpression and incidence of triple negative breast cancer which warrant further investigation. Malay women present with larger tumours and at later stages, and even after adjustment for these and other prognostic factors (stage, pathology and treatment), Malay women have a poorer survival. Although the factors responsible for these ethnic differences have not been elucidated, it is thought that pharmacogenomics, lifestyle factors (such as weight-gain, diet and exercise), and psychosocial factors (such as acceptance of 2nd or 3rd line chemotherapy) may be responsible for the difference in survival. Notably, survivorship studies show self-management programmes and exercise improve quality of life, highlighting the need to evaluate the psychosocial impact of breast cancer on Malaysian women, and to design culturally-, religiously- and linguistically-appropriate psycho-education programmes to help women cope with the disease and improve their quality of life. Research done in the Caucasian populations may not necessarily apply to local settings and it is important to embark on local studies particularly prevention, screening, diagnostic, prognostic, therapeutic and psychosocial research.
    Matched MeSH terms: Evidence-Based Medicine
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