Validation of nutritional screening tools against anthropometric and functional assessments among elderly people in selangor

This cross sectional study was conducted to determine the validity of three screening tools, Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Risk Screening Tool for Community (MRST-C) and Malnutrition Risk Screening Tool for Hospital (MRST-H) among elderly people at health clinics. The screening tools were validated against anthropometric and functional assessments. The anthropometric assessments that were carried out included body weight, height, arm span, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A set of questionnaire on manual dexterity, muscular strength, instrumental activities daily living (IADL) and cognitive status was used to assess functional abilities. A total of 156 subjects were recruited from rural (38 subjects) and urban (118 subjects) health clinics at Sabak Bernam and Cheras respectively. Subjects' age ranged from 60 to 83 years old, with 44.2% were men and 55.8% women. The prevalence of muscle wasting among the subjects assessed from MUAC and CC were both 7.0%. MNA-SF had the highest correlation with BMI (r = 0.497, p<0.001), followed by MUAC (r = 0.398, p<0.001), CC (r = 0.473, p<0.001), cognitive assessment (r = 0.229, p<0.001) and handgrip strength (r = 0.209, p<0.001). Whilst MRST-C had the highest correlation with IADL score (r =-0.320, p<0.001) and MRST-H had the highest correlation with the lock and key test (r = -0.325, p<0.01). Sensitivity was the highest for MNA-SF (93.2%), followed by MRST-H (52.5%) and MRST-C (25.8%). Specificity was the highest for MRST-H (97.3%), followed by MRST-C (90.8%) and MNA-SF (79.4%). Positive predictive value (PPV) for MRST-H, MNA-SF and MRST-C was 55.5%, 18.2% and 14.1%, respectively. In conclusion, among the screening tools being validated, MNA-SF is considered the most appropriate tool to be used in health clinics for identification of elderly individuals who are at high risk of malnutrition.     

Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy

Breast Cancer Research and Treatment - Studies that report equivalent oncologic outcomes of sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for T1-2N1mi breast...     

Nucleus Detection on Pap Smear Images for Cervical Cancer Diagnosis: A Review Analysis

Cervical cancer is a cell disease in the cervix that develops out of control in the female body. The cervix links the vagina (birth canal) with the upper section of the uterus, which can only be found in the female body. This is the second leading cause of death among women around the world. However, cervical cancer is currently one of the most preventable cancers if early detection is identified. The effect of unidentified cancer may increase the risk of death when the cell disease spreads to other parts of the female anatomy (metastasize). The Papanicolaou test is a cervical cancer screening technique used to identify potentially precancerous and cancerous cells in women’s cervix. In this paper, a few popular detection method was applying and experimented on pap smear images. A few image quality assessment (IQA) was obtained in order to determine the best of detection method. The nucleus detection will help pathologists to diagnosis in early stages of cancer. The early detection is very important stage in order to reduce the cancer incidence and mortality. The method that needs to be invented in this study is the detection method. Image detection is the process of partitioning the image into multiple regions. The detection method is object detection and recognition as well as the boundary in images. The segmented Pap Smear image is one of the detection tools with many different methods that generated different results from different issues. The solution was by analysing different existing detection methods in order to compare the dissimilar performance of existing processes. The precision of the system performance needs to be improved in order to invent a new method. As predicted from the result, the innovative construction method must be proposed and compared in order to find accurate, comprehensive measures and proper sampling procedures by the features of the selection method.     

Effectiveness of chemotherapy counselling on self-esteem and psychological affects among cancer patients in Malaysia: Randomized controlled trial

Objectives

The aim of this study was to implement and evaluate the outcomes of chemotherapy counselling based on the “Managing Patients on Chemotherapy” module on self-esteem and psychological affect (anxiety, depression) of cancer patients by pharmacists in ten selected government hospitals in Peninsular Malaysia.

Antibodies to GAD65 and a tyrosine phosphatase-like molecule IA-2ic in Filipino type 1 diabetic patients

OBJECTIVE: Type 1 diabetes is more prevalent in Europeans than it is in Asians. The disease is associated with autoantibodies to GAD65 and a protein tyrosine phosphatase-like molecule (IA-2). The frequency of GAD antibodies in Asian patients with type 1 diabetes may be lower than that in Europeans. No data are available on IA-2 antibodies in Asians. We tested antibodies to GAD65 and IA-2ic (the intracellular fragment containing the antibody epitope) in Filipino diabetic patients because this population has mixed European and aboriginal racial origins. RESEARCH DESIGN AND METHODS: A cross-sectional study of antibodies to GAD65 and IA-2ic was performed on a consecutive series of 91 type 1 diabetic patients, 74 type 2 diabetic patients, and 100 control subjects attending a diabetes clinic in Manila, the Republic of the Philippines. All subjects were <40 years of age, with a mean age +/- SD of 24.8+/-9.8, 34.3+/-5.8, and 25.8+/-8.0 years, respectively. Diagnosis of type 1 diabetes was determined clinically and confirmed by baseline C-peptide. RESULTS: Of 91 type 1 diabetic patients, antibodies to GAD65 were detected in 25 (27.4%), but antibodies to IA-2ic were found in only 8 (8.8%) (P = 0.002); neither autoantibody was detected in either the type 2 diabetic or control subjects. Of the 25 recently diagnosed type 1 diabetic patients (disease duration <2.0 years), autoantibodies to GAD65 were detected in 14 (56%), but those to IA-2ic in only 4 (16%) (P = 0.007); GAD65 antibodies were detected in only 4 (6%) of 66 patients with a longer disease duration (P = 0.0004). Comparison with recently diagnosed European type 1 diabetic patients of age and disease duration similar to that of the Filipinos indicated that IA-2ic antibodies, unlike GAD antibodies, were significantly less prevalent in Filipino type 1 diabetic patients (P = 0.0007). CONCLUSIONS: This is the first study investigating the prevalence and pattern of humoral immune response in type 1 diabetic patients from the Philippines. Antibodies to IA-2ic, unlike GAD antibodies, were infrequent. Patterns of immune responses to type 1 diabetes-associated antigens may differ worldwide, with important implications for prediction of the disease and the potential for antigen-specific therapy.     

Proteomic and histopathological characterization of the interface between oral squamous cell carcinoma invasion fronts and non-cancerous epithelia

Oral squamous cell carcinomas (SCCs) are frequently associated with pre-invasive lesions including carcinoma in-situ (CIS), and CISs further form lateral interfaces against surrounding normal or dysplastic epithelia (ND). At the interface where keratin (K) 17 positive (+) SCC/CIS cells are in contact with K13 + ND cells, “cell competition” must be evoked between two such different cell types. Thus, the aim of this study was to characterize the histopathology of the SCC/CIS-ND interface and to determine protein profiles around the interface by proteomics. A total of 112 lateral interfaces were collected from 55 CIS and 57 SCC foci, and they were investigated by immunohistochemistry and liquid chromatography-tandem mass spectrometry. The interfaces were morphologically classified into three types: vertical, oblique, and convex. There were several cellular changes characteristic to the interface, including apoptosis and hyaline bodies, which were more emphasized in SCC/CIS sides. The results suggested that ND cells were winners of cell competition against SCC/CIS cells. Then, the interfaces were divided into four vertical segments, and each segment was separately laser-microdissected from tissue sections with immunostaining for K13 or K17; the four segments included SCC/CIS away from (#1) or adjacent to (#2) the interface, and ND adjacent to (#3) or away from (#4) the interface. Proteome analyses revealed approximately 4000 proteins from SCC/CIS sides [#1 and #2] and 2800 proteins from ND sides [#3 and #4]. We quantitatively selected the top 25 proteins including ladinin-1 or interleukin-1 receptor antagonist protein, which were most contrastively increased or decreased in SCC/CIS or ND sides, respectively, and their specific immunohistochemical expression modes were confirmed in tissue sections as well as in cultured SCC cells. These molecules should be involved in the cellular crosstalk toward cell competition at the lateral interface of oral SCC/CIS and would be new candidates for histopathological distinction of oral malignancies.     

The use of web-based interventions to prevent excessive weight gain

We reviewed web-based interventions for overweight and obesity prevention. A literature search was conducted using seven electronic databases. Manually searched articles were also included. Thirty studies fulfilled the inclusion criteria. Of these, 13 studied physical activity, eight studied dietary practices and nine studied a combination of physical activity and dietary practice. Twenty-eight of the studies (93%) reported positive changes in moderate to vigorous physical activity level, fruit and vegetable intake and psychological factors. A meta-analysis showed there were improvements, though not significant, in fruit and vegetable consumption (standardised mean difference, SMD = 0.61; 95% CI =-0.13 to 1.35) and physical activity (SMD = 0.15; 95% CI =-0.06 to 0.35). The review suggests that web-based interventions are a useful educational tool for increasing awareness and making healthy behaviour changes in relation to an excessive weight gain problem.     

Enhancing hand hygiene in a polyclinic in Singapore

Aims This project intended to enhance the compliance rate of nurses (registered nurses and enrolled nurses) in a polyclinic to the five moments of hand hygiene. It proposed to conduct a preliminary baseline audit on the standard of hand hygiene practice, educate nurses on the five moments of hand hygiene in the polyclinic and conduct a post-implementation audit to capture the compliance rate of nurses on practising the five moments of hand hygiene. Methods The team conducted a pre- and post-implementation audit using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programme, from July 2011 through November 2011, over a period of 5?months. The pre-implementation audit, which involved 23 nurses from a polyclinic in Singapore, also adopted five out of the seven criteria suggested by the Joanna Briggs Institute. The intervention composed of educating the nurses on the five moments of hand hygiene, providing guidance to nurses in a non-intimidating manner, adopting an open communication approach and the appropriate placement of alcohol-based hand rub at the point of care in the service rooms. Results The post-implementation audit results showed significant improvement in four of the five criteria, with the greatest improvement observed for criterion 2: 'Hands are decontaminated immediately before each and every episode of direct patient contact or care, and/or all inanimate objects, including equipment'. Conclusion This study has proven that by conducting the pre- and post-implementation audit using the five criteria gathered from the Joanna Briggs Institute Practical Application of Clinical Evidence System, nurses' hand hygiene compliance can be enhanced. From this study, we could also conclude that nurses' knowledge and accessibility/suitability of alcohol-based hand rubs play an important role in achieving better hand hygiene practices. Positive results were seen even though the project was conducted within a short period. Contributing factors could be attributed to efforts by researchers in identifying barriers for compliance from the ground and addressing them in the intervention phase. In addition, the relentless enthusiasm and commitment of stakeholders, team members and nurses had also contributed to the success of this study. This project was the first to report an improvement in the hand hygiene compliance of primary healthcare nurses in Singapore.