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Fulltext Assessing Frailty in the General Medical Clinic of a Tertiary Hospital in Northern Malaysia: The FRAIL Scale or the Clinical Frailty Scale

Thiam CN, Ooi CY, Seah YK, Chuan DR, Looi I, Ch'ng ASH

Curr Gerontol Geriatr Res, 2021;2021:7570592.
PMID: 34394346 DOI: 10.1155/2021/7570592

Background: Frailty potentially influences clinicians' decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia.
Methods: The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS.
Results: The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p=0.481). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients.
Conclusion: Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.
Feasibility of quick response-based quality improvement projects in an urban primary care setting: A cross-sectional survey

Yeoh ZY, Beh HC, Amirul Amzar Megat Hashim MM, Haireen AH, Chuan DR, Othman S

Malays Fam Physician, 2024;19:57.
PMID: 39534763 DOI: 10.51866/oa.653

INTRODUCTION: Using quick response (QR) codes to disseminate information has become increasingly popular since the declaration of COVID-19 as a pandemic. We aimed to investigate the feasibility of implementing QR-based quality improvement projects in our clinic to improve patients' medical knowledge, experience and access to care.
METHODS: We utilised systematic random sampling by recruiting every 25th patient registered in our clinic during data collection. Participants answered a self-administered printed questionnaire regarding their smartphone usage and familiarity with QR code scanning at the patients' waiting area. Data were analysed using the Statistical Package for the Social Sciences version 26.
RESULTS: A total of 323 patients participated (response rate=100%). The participants' median age was 57 years (interquartile range=4l-67). Most participants were women (63.1%). Approximately 90.4% (n=282) used smartphones, with 83.7% (n=261) reporting average or good usage proficiency. More than half (58.0%) accessed medical information via their smartphones, and 67.0% were familiar with QR codes. Multiple logistic regression analyses revealed that familiarity with QR codes was linked to age of <65 years [adjusted odds ratio (AOR)=4.593, 95% confidence interval (CI)=2.351-8.976, P<0.001], tertiary education (AOR=2.385, 95% CI=1.170-4.863, P=0.017), smartphone proficiency (A0R=4.703, 95% CI= 1.624-13.623, P=0.004) and prior smartphone usage to access medical information (AOR=5.472, 95% CI=2.790-10.732, P<0.001).
CONCLUSION: Since smartphones were accessible to most primary care patients, and more than half of the patients were familiar with QR code scanning, QR code-based quality improvement projects can be used to improve services in our setting.
Fulltext Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis

Loh HC, Lim R, Lee KW, Ooi CY, Chuan DR, Looi I, et al.

Stroke Vasc Neurol, 2021 Mar;6(1):109-120.
PMID: 33109618 DOI: 10.1136/svn-2020-000519

There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92-1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77-1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88-1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85-0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98-1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827.

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