Medical students’ perceptions on the adequacy and effectiveness of pharmacology teaching during preclinical years

Pharmacology teaching during preclinical years is important for medical students to make rational choices in choosing suitable treatment for patients in future. Therefore, the present study determined the adequacy and effectiveness of pharmacology teaching in the undergraduate medical program at the Universiti Kebangsaan Malaysia Medical Center (UKMMC). Suggestions for improvement of the curriculum were also identified. An online questionnaire on the perceptions of pharmacology teaching methodology was distributed to a total of 459 medical students in 4th and 5th year at UKMMC. The questionnaire covered demographics, perceptions about pharmacology teaching, the ideal teaching learning methodology for learning pharmacology, pharmacology topics which are useful for future clinical practice, the pharmacology topic which was most interesting and recommendations for improvement. The response rate was 46.4% and majority of the participants were females (65.7%). Most of the students agreed that interactive learning was more helpful than didactic lectures (88.0%). Seventy percent of the students reported that pharmacology lectures in the preclinical years were helpful during the clinical years. Percentage of students who agreed that pharmacology teaching in their preclinical was adequate for their clinical practice was 47.0%. There was no association between demographic variables (gender, race, year of study and medical family background) and interest in pharmacology (p>0.05). In conclusion, the pharmacology teaching during preclinical years was perceived to be effective and useful for students’ clinical practice. More pharmacology teaching sessions in clinical years was suggested which may improve adequacy of pharmacology teaching

Effectiveness of the EMPOWER-PAR intervention in improving clinical outcomes of type 2 diabetes mellitus in primary care: a pragmatic cluster randomised controlled trial

Background: The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. Methods: This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect. Results: A total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. control: 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. control: −4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34–3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes. Conclusions: This study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting

Complication profiles and their associated factors in Malaysian adult type 2 diabetes mellitus—an analysis of ADCM registry

Early detection and treatment of risk factors in type 2 diabetes mellitus (T2D) have been proven in reducing complications, improving survival and quality of life. This study aimed to examine an overall diabetes-related complication profiles and their associated factors in adult T2D. Adult diabetes control and management (ADCM) is a prospective registry that included patients with T2D in 2009. Complication profiles were reported descriptively. Multivariate analyses adjusted for differences in patient characteristics were used to determine the associated factors for diabetes-related complications categorised as microvascular complication (microCx) such as retinopathy and nephropathy and macrovascular complication (macroCx) such as ischaemic heart disease and cerebrovascular accident and both complications (combined microCx and macroCx). Complete data were available for 57,780 patients (81.5 %) with a mean age of 58.3 (SD 11.27) years; 59.7 % were female. About one fifth (10,834/57,780) of T2D patients were diagnosed with at least one complication. Ethnicity, gender, duration of T2D and co-morbids, under hospitals with specialist (HS) care, glycaemic and low-density lipoprotein-cholesterol (LDL-C) targets were associated with complications. When compared to T2D patients without complication, patients who were older (OR 1.03), male (OR 1.48), had longer duration of diabetes (OR 1.04) and hypertension (OR 1.03) and under the care HS (OR 13.64) were more likely to have both complications. T2D patients had moderate morbidity burden. Older age and male gender were two main risk factors of all types of complications. T2D patients with these associated factors should be monitored for prevention, screening and early treatment of diabetes-related complications. T2D patients under the HS care were noted to have also more complications could be due to HS had been centres of referral for advanced diabetes care rather than the result of HS care itself