ORCID Profile
0000-0003-3191-1264
Current Organisation
Universiti Malaya
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Publisher: Springer Science and Business Media LLC
Date: 21-06-2014
Publisher: Springer Science and Business Media LLC
Date: 23-06-2018
Publisher: Springer Science and Business Media LLC
Date: 20-09-2022
DOI: 10.1038/S41533-022-00294-8
Abstract: 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, www.isrctn.com/ISRCTN87128530 .
Publisher: Springer Science and Business Media LLC
Date: 27-03-2023
DOI: 10.1038/S41533-023-00337-8
Abstract: Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.
Publisher: Springer Science and Business Media LLC
Date: 16-04-2014
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD. We conducted a qualitative study with doctors and patients in Malaysia. We used convenience s ling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach. The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word ‘asthma’ was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care. In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit.
Publisher: Medknow
Date: 28-05-2012
DOI: 10.1038/AJA.2011.178
Publisher: Research Square Platform LLC
Date: 31-08-2022
DOI: 10.21203/RS.3.RS-1848944/V1
Abstract: Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in public primary health clinics in Malaysia. A total of six clinics participated. Here, we found only four had dedicated asthma clinics. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, however not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in important areas of the clinic. To diagnose asthma, most doctors used clinical judgement, peak flow meter measurements with reversibility test. Although spirometry is the recommended method to diagnose asthma, it was less practiced, being inaccessibility and unskilled in using as the main reasons. Most doctors reported providing asthma self-management asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow meter measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.
Publisher: Medknow
Date: 09-2015
Publisher: SAGE Publications
Date: 11-2018
Abstract: Good nutrition for infants, during the first 1000 days from conception, is one of the most important determinants of a healthy long life. Breastfeeding is the most important component of infant nutrition and reduces morbidity and mortality. With the changes to the climate currently occurring, issues of nutrition and food supply are only going to increase in importance. The Sustainable Development Goals of the United Nations, place nutrition at the forefront of world development and a sustainable planet. The vision of Asia-Pacific Academic Consortium for Public Health (APACPH) is to “achieve the highest possible level of health of all the people of the nations of the Asia-Pacific region.” Much of the burden of disease, early deaths, and disability in the Asia Pacific region could be reduced with public health efforts to address the major risk factors, including nutrition-related causes and smoking. The United Nations Decade of Action on Nutrition 2016-2025 has recently been launched with the aim of reducing the global burden of inappropriate nutrition. The goals include increasing rates of exclusive breastfeeding to 6 months, reducing wasting and stunting, and reducing the rates of low birthweight. This is the position endorsed in these guidelines along with the principles of the Baby Friendly Hospital Initiative. These guidelines expand the information on infants that was included in the 2016 APACPH Dietary Guidelines. APACPH covers many different environments, geographical areas, cultures, and socioeconomic groups. These guidelines are generally applicable to all infants in our region, specific local advice may sometimes be needed.
Publisher: Public Library of Science (PLoS)
Date: 05-05-2015
Publisher: Public Library of Science (PLoS)
Date: 25-04-2018
Publisher: Public Library of Science (PLoS)
Date: 03-08-2018
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 11-2022
Abstract: BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022. METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis. RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs 2) limited data on CRD burden and treatments in LMICs 3) ineffective procurement and distribution networks and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice 2) capacity building 3) improved procurement mechanisms 4) strengthened advocacy practices and 5) a World Health Assembly Resolution. CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.
Publisher: Wiley
Date: 17-11-2011
Publisher: SAGE Publications
Date: 09-2012
Publisher: Journal of Infection in Developing Countries
Date: 31-08-2023
DOI: 10.3855/JIDC.16967
Publisher: Wiley
Date: 12-04-2013
DOI: 10.1111/BJU.12037
Abstract: To evaluate the efficacy and safety of long-acting i.m. testosterone undecanoate (TU) in Malaysian men with testosterone deficiency (TD). A total of 120 men, aged 40-70 years, with TD (serum total testosterone [TT] ≤ 12 nmol/L) were randomised to receive either i.m. TU (1000 mg) or placebo. In all, 58 and 56 men in the placebo and treatment arm, respectively, completed the study. Participants were seen six times in the 48-week period and the following data were collected: physical examination results, haemoglobin, haematocrit, TT, lipid profile, fasting blood glucose, sex hormone-binding globulin, liver function test, prostate- specific antigen (PSA) and adverse events. The mean (sd) age of the participants was 53.4 (7.6) years. A significant increase in serum TT (P < 0.001), PSA (P = 0.010), haematocrit (P < 0.001), haemoglobin (P < 0.001) and total bilirubin (P = 0.001) were seen in the treatment arm over the 48-week period. Two men in the placebo arm and one man in the treatment arm developed myocardial infarction. Common adverse events observed in the treatment arm included itching/swelling ain at the site of injection, flushing and acne. Overall, TU injections were well tolerated. TU significantly increases serum testosterone in men with TD. PSA, haemoglobin and haematocrit were significantly elevated but were within clinically safe limits. There was no significant adverse reaction that led to the cessation of treatment.
Publisher: Public Library of Science (PLoS)
Date: 22-10-2015
Publisher: SAGE Publications
Date: 09-06-2011
Abstract: This study aimed to compare the process of care and the choice of antihypertensive medications used in both public and private primary care clinics in Malaysia. A cross-sectional survey was completed in 2008 on randomly selected 100 public health clinics and 114 private primary care clinics in Malaysia. A total of 4076 patient records, 3753 (92.1%) from public clinics and 323 (7.9%) from private clinics were analyzed. Less than 80% of the records documented the recommended clinical and laboratory assessments. The rates of documentation for smoking status, family history of premature death, retinal assessment, and urine albumin tests were lower in public clinics. Overall, 21% of the prescription practices were less than optimal. The process of care and the use of antihypertensive medications were not satisfactory in both settings.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2013
No related grants have been discovered for Ee Ming Khoo.