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Stroke is a prevalent issue within the community as the diagnosis of stroke plays an essential role in the Quality of life (QoL) of the patient. This study is a Systematic Literature Review (SLR) of QoL of stroke patients according to the statement of Preferred Reporting Items for Systematic Review (PRISMA). A published article between 2008 to 2020 from four databases namely EBSCO Medline, Ovid, PubMed and Science Direct were included in the study. After the identification and screening process, 37 articles were reviewed thoroughly in the study. Analysis of these 37 articles revealed the QoL of stroke patients is poor compared to the general population. The diagnosis of stroke impacted both physical and mental dimension of QoL in which the most impacted domain was reported to be the physical domain. Among the influential factors towards QoL were age, patient’s disability, gender, patient’s comorbidity, income status and family support. To improve the QoL of the patients, it’s highly imperative to consider the factors influencing QoL in the treatment plan of the patients.

The Community-Based Rehabilitation (CBR) services under the Malaysian Ministry of Women, Family and Community Development have provided two types of services for disabled children: centre-based and home-based care since 1984. A cross-sectional study was conducted among parents and caregivers with children receiving treatment at CBRs on the east coast of Peninsular Malaysia, to determine the level of satisfaction with the services provided. Respondents were recruited via multi-staged sampling, and simple randomisation at CBR level. Respondents self-administered the Physical Therapy Satisfaction Questionnaire (PTSQ) and provided sociodemographic data. A total of 297 respondents were recruited and all the questionnaires were returned complete, making the response rate 100%. Total satisfaction scores and factors influencing respondents’ satisfaction for both groups were analysed. The mean total satisfaction score for centre-based and home-based were 84.69 (SD = 10.01) and 75.30 (SD = 12.23; t = 7.160, p ≤ .001) respectively. Ninety-eight per cent of centre-based and 89% of home-based respondents were satisfied with the current services. There were significantly mean differences in the satisfaction level of respondents of different states respectively (Kelantan mean 84.92 10.83, Terengganu mean 77.49 11.16 and Pahang mean 77.47 12.93, p ≤ .001). Factors associated with satisfaction were education (p = .002), occupation (p =

Background Lower urinary tract symptoms (LUTS) are common among elderly men. However, seeking help for this problem is mostly delayed until complications arise. Primary care clinics serve as the first point of contact for a person’s health needs throughout their life. This study aimed to determine the prevalence of LUTS among primary care attendees, and the factors that influence seeking medical intervention at primary care clinics. Methods Using a universal sampling technique, 460 male patients aged 60 and above visiting an urban based public primary care clinic were recruited. An interviewer administered the questionnaire which used International Prostate Symptoms Score and International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms-Quality of Life. Results The prevalence of any LUTS and clinically significant LUTS were 89.8% and 20.5%, respectively. Among the 385 participants who completed the study, only 41.8% had consulted a doctor for LUTS. Among those with moderate/severe symptoms only 57.6% had sought medical intervention. Multiple logistic regression analysis showed that the presence of more than two comorbidities (P=0.004; odds ratio [OR], 4.695; 95% confidence interval [CI], 1.632–13.508) and quality of life (P=0.002; OR, 1.271; 95% CI, 1.091–1.481) were independent factors significantly associated with seeking help. Conclusion Prevalence of LUTS among elderly men undergoing primary care is high, but more than half of the patients had not sought medical attention. Increasing comorbidities and impact on quality of life influenced elderly men with LUTS to seek help.

Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study. Results One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge. Conclusions The SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes. Trial registration No.: ACTRN12616001322426 (Registration Date: 21st September 2016.

Background: This paper describes a study to evaluate the readability scores of Malaysian newspaper articles meant to create awareness of diabetes among the public. In contrast to patient-specific sources of information, mass media may potentially reach healthy people and help them avoid becoming part of the diabetes statistics. The study selected relevant samples from the Malaysian Diabetes Corpus and used an online tool to score and display their readability using Flesch Kinkaid Reading Ease (FKRE) as the main indicator. Result: The average readability for the materials is low at 49.6 FKRE, which may impede the uptake of information contained in the articles. Trend analysis reveals that there is not much variability in the years covered by the corpus with the articles from 2016 scoring better than other years. Feature analysis of articles with the best and worst readability indicates that medical practitioners may not be the best spokesperson to reach the public. It also indicates that simple sentence structures could help improve readability. Conclusion: There is still much room for improvements in attaining good public health literacy through mass media communication. Public health and media practitioners should be vigilant of the language aspects of their writing when reaching out to the public.

Background The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge of the oral health effects of diabetes. Likewise, dentists treating patients receiving diabetes treatment are rarely updated on the glycaemic status and as a result, the opportunity for shared management of these patients is missed. This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care for them to receive optimised care for glycaemic control. Method A Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique where the experts comprised Family Medicine Specialists (5), Periodontists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services. Results The CODAPT© panel recommends referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to the dental healthcare team is outlined specifically. Conclusion The CODAPT© care pathway has the potential to link dental clinics with primary care for diagnosis and/or optimised treatment of prediabetes/diabetes among patients receiving periodontitis treatment.

Background The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is compounded by the lack of assessment of preparedness of future healthcare workers to manage complications related to ageing i.e., dementia. Studies in countries with NDS demonstrated lack of dementia knowledge among medical undergraduates. Hence, this study aimed to assess the knowledge on dementia among final year medical undergraduates in Malaysia and its associated factors, using the Dementia Knowledge Assessment Scale (DKAS). Methods This cross-sectional study, employed multistage sampling method to recruit final year medical undergraduates from eleven selected public and private medical institutions across Malaysia. Online self-administered measures were delivered to final year medical undergraduates through representatives of medical students’ society after approval from Deanery and institutional ethics board of participating universities. The measure collected demographic information, previous dementia exposure (i.e., formal or informal) and the 25-item Likert scale DKAS. Bivariate analysis and linear regression were conducted to confirm factors influencing dementia knowledge components. Results A total of 464 respondents from 7 universities participated in this study. Overall dementia knowledge among respondents with and without exposure, was low, with average score of 29.60 ± 6.97 and 28.22 ± 6.98, respectively. DKAS subscales analysis revealed respondents scored highest in care consideration subscale (9.49 ± 2.37) and lowest in communication and behaviour subscale (4.38 ± 2.39). However, only causes and characteristic subscale recorded significantly higher knowledge score among respondents with previous exposure (7.88 ± 2.58) (p =0.015). Higher knowledge of dementia was associated with previous formal dementia education (p=0.037) and informal occupational/working experience in caring for dementia patients (p = 0.001). Informal occupational/working experience (B = 4.141, 95% CI 1.748–6.535, p = 0.001) had greater effect than formal education (i.e. lectures/workshops) (B = 1.393, 95% CI 0.086–2.700, p = 0.037) to influence respondents’ knowledge on dementia. Conclusion Dementia knowledge among final year medical undergraduates is low. To improve dementia knowledge, Malaysian medical curriculum should be reviewed to incorporate formal education and informal occupational/working experience, as early as in undergraduate training to help prepare future healthcare providers to recognise dementia among ageing Malaysians.

Introduction The sudden undertaking of being a caregiver for a spouse or family member afflicted with a stroke can cause adverse psychological consequences. In Malaysia, the majority of stroke patients return home to be cared for by family members and continue rehabilitation as outpatients. In most local urban communities, the practice of shared caregiving is observed among stroke caregivers either out of necessity or familism. Sole or primary caregivers who share their homes with stroke patients would be more challenged physically and psychologically compared to secondary or joint caregivers. Sharing the caregiving responsibilities is believed to lighten the burden on primary caregivers. This study aims to determine the proportion and associated factors of depression among urban-dwelling caregivers of home-bound stroke patients receiving long-term care from a university-based primary care clinic. Methodology A cross-sectional study involving 123 primary and secondary caregivers of stroke patients was conducted at Klinik Primer PPUKM Cheras (KPPC) and the outpatient Medical Rehabilitation Services Department Hospital Canselor Tuanku Muhriz (HCTM), Cheras Kuala Lumpur. A self-administered questionnaire comprising of sociodemographic characteristics, the Beck Depression Inventory-II (BDI-II), and the Multidimensional Scale of Perceived Social Support questionnaire (MSPSS) was used. The functional status of the stroke patients was assessed using the Modified Rankin Score (MRS). Results The proportion of respondents with depression was 20.3% (n=25). Depression was associated with caregivers’ age (CI=42.23-50.09, p=0.016), presence of illness (p=0.001), and being a sole caregiver (p=0.001). There is also an association found between caregiver depression with longer duration post-stroke (CI= 12.75-16.13, p

Background and objective Despite the widespread use of traditional and complementary medicine (TCM) during pregnancy, very few studies have focused on the use of these practices during the postpartum period among women in Malaysia. This study aimed to evaluate users' profiles and factors associated with the use of TCM during the postpartum period among women attending a community clinic in rural Malaysia. Materials and methods A cross-sectional study was conducted among 210 women at a maternal and child health clinic in Bagan Serai, Perak, Malaysia from January to April 2019. A self-administered questionnaire was used to determine the prevalence, the different types, and reasons for the use of TCM and perceptions toward TCM. Factors associated with TCM use during the postpartum period were derived from multiple logistic regression analyses. Results The prevalence of TCM use during the postpartum period was 66.2% among the subjects. The most common type of TCM used was massage (88.3%), and the most common reason reported was to improve general well-being (72.1%). "Family belief" had the highest mean for influence toward TCM use (mean: 3.63). Malays (adj. OR: 4.52, 95% CI: 1.93-10.59, p=0.001) and those having a low monthly household income (adj. OR: 3.68, 95% CI: 1.24-10.91, p=0.019) were the groups that were more likely to use TCM. Conclusion TCM use during the postpartum period is highly prevalent among Malay women with low household monthly incomes. Further studies should be conducted to address the benefits and risks of using TCM during the postpartum period.

Background and objectives Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. Methods Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. Results Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35–64 (AORs: 0.61–0.75), p values Conclusion The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.

Background Most family caregivers of stroke patients in Malaysia do not receive adequate prior preparation or training. This study aimed to determine levels of patient positioning knowledge and caregiving self-efficacy among caregivers of stroke patients. Methods This cross-sectional study was conducted at an urban teaching hospital involving 128 caregivers of stroke patients. The caregivers were conveniently sampled and completed the data collection forms, which comprised their socio-demographic data, patients' functional status, the Caregiving Knowledge For Stroke Questionnaire: Patient Positioning (CKQ-My© Patient Positioning) to measure caregiver's knowledge on patient positioning, and the Family Caregiver Activation Tool (FCAT©) to measure caregivers' self-efficacy in managing the patient. Descriptive and multivariate inferential statistics were used for data analysis. Results Among the caregivers sampled, 87.3% had poor knowledge of positioning (mean score 14.9 ± 4.32). The mean score for FCAT was 49.7 ± 6.0 from a scale of 10 to 60. There was no significant association between knowledge on positioning and self-efficacy. Multiple linear regression showed that caregivers' age (B = 0.146, p = 0.003) and caregiver training (B = 3.302, p = 0.007) were independently associated with caregivers' self-efficacy. Conclusion Caregivers' knowledge on the positioning of stroke patients was poor, despite a fairly good level of self-efficacy. Older caregivers and receiving caregiver training were independently associated with better caregiver self-efficacy. This supports the provision of caregiver training to improve caregiver self-efficacy.

Background The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS©) was designed to guide primary care teams to incorporate further rehabilitation and regular screening for post stroke complications among patients residing at home in communities, using the shared-care approach, especially in areas with limited access to specialist stroke care services. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. This study aimed to evaluate the cost effectiveness and impact of iCaPPS© on quality-adjusted- life-years (QALY) compared with current conventional monitoring at public primary care healthcentres. Methods A pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS© (n = 86) vs conventional care (n = 65) for 6 months. Costs from societal perspective were calculated, using combination of top down and activity-based costing methods. The 5-level EQ5D (EQ-5D-5 L) was used to calculate health state utility scores. Cost per QALY and incremental cost effectiveness ratio (ICER) were determined. Differences within groups were determined using Mann-Whitney tests. Results Total costs for 6 months treatment with iCaPPS© was MYR790.34, while conventional care cost MYR527.22. Median QALY for iCaPPS© was 0.55 (0,1.65) compared to conventional care 0.32 (0, 0.73) (z = − 0.21, p = 0.84). Cost per QALY for iCaPPS© was MYR1436.98, conventional care was MYR1647.56. The ICER was MYR1144.00, equivalent to 3.7% of per capita GDP (2012 prices). Conclusions Management of post stroke patients in the community using iCaPPS© costs less per QALY compared to current conventional care and is very cost effective. Trial registration Trial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).

Background: Despite being a common problem, long-term disability following stroke often improves after survivors receive regular rehabilitative therapy. This study aimed to assess the oral health-related quality of life (OHRQoL) of stroke survivors who had access to a community-based rehabilitation centre after hospital discharge. Methods: Dentate post-stroke patients receiving regular rehabilitative care with slight to moderate dependency (Barthel Index >70) and without severe cognitive impairment were involved in this study. The OHRQoL parameters were measured using the Oral Health Impact Profile-14 (OHIP-14) and EuroQol five dimensions (EQ-5D-5L) questionnaires. Results: Thirty one patients were recruited in this study. Majority of the patients hardly ever or never had problems in all functional, physical, psychological and social domains, including eating discomfort and having to avoid eating, difficulty in chewing food and presumably having bad breath (58.1%, 61.3% and 71.0% respectively). Other than gender, age, ethnicity, co-morbidities and oral hygiene practices, education level was the only variable found to significantly affect patients’ OHRQoL (p = 0.028). Most of the patients had no or slight problem(s) in self-care (87.1%) and carrying out usual activities (57.1%), pain/discomfort (3.2%) and anxiety/depression (6.5%). Conclusion: Stroke survivors under regular rehabilitative care perceived have good oral health-related quality of life.

Introduction: Stroke survivors are commonly at risk of functional decline, which increase their dependency in activities of daily living and eventually affects their motivation level, self-efficacy, and quality of life. Circuit exercise has been shown to be useful in enhancing functional performance and quality of life of chronic stroke survivors. There is a need to review the existing “usual circuit exercise” and develop a better approach, such as game-based circuit exercise. Training in enriched and fun environment may possibly further promote neuroplasticity. However, evidence on inducing fun element in the existing circuit exercise among stroke survivors is limited. Also, no studies are available to date which report the benefit of circuit exercise on stroke survivors’ self-efficacy and motivation level. Therefore, this study aims to assess the effectiveness of game-based circuit exercise in comparison to conventional circuit exercise on functional outcome (lower limb strength, postural stability and aerobic endurance), motivation level, self-efficacy and quality of life among stroke survivors. This study also aims to assess whether the outcomes gained from the 2 interventions could be sustained at week 12 and 24 post-trial. Methods: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are game-based circuit exercise (experimental group) and conventional circuit exercise (control group). Based on sample size calculation using GPower, a total number of 82 participants will be recruited and allocated into either the experimental or the control group. Participants in the experimental group will receive a set of structured game-based exercise therapy which has the components of resistance, dynamic balance and aerobic exercises. While participants in the control group will receive a conventional circuit exercise as usually conducted by physiotherapists consisting of 6 exercise stations; cycling, repeated sit to stand, upper limb exercise, lower limb exercise, stepping up/down and walking over obstacles. Both groups will perform the given interventions for 2 times per week for 12 weeks under the supervision of 2 physiotherapists. Outcomes of the interventions will be measured using 30-second chair rise test (for lower limb strength), Dynamic Gait Index (for postural stability), 6-minute walk test (aerobic capacity), Intrinsic Motivation Inventory questionnaire (for motivation level), stroke self-efficacy questionnaire (for self-efficacy) and Short Form-36 quality of life questionnaire (for quality of life). All data will be analyzed using descriptive and inferential statistics. Discussion: This study will provide the information regarding the effectiveness of including game elements into circuit exercise training. Findings from this study will enable physiotherapists to design more innovative exercise therapy sessions to promote neuroplasticity and enhance functionality and quality of life among stroke survivors under their care. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN 12621001489886 (last updated 1/11/2021)

Aim: The majority of caregivers for stroke patients in Malaysia are informal caregivers, although there are no valid tools to measure their knowledge regarding caregiving. Therefore, this study validated the Caregiving Knowledge Questionnaire (CKQ-My) as an assessment of Malaysian stroke caregivers' knowledge regarding patient positioning and feeding. Methods: Back-to-back translation was used to produce a bilingual version of the questionnaire. Hand drawings were used to replace photographs from the original questionnaire. Face validity and content validity were assessed, and construct validity was determined by comparing responses from informal caregivers, medical students, and primary care doctors. Finally, the internal consistencies of the subscales were determined. Results: Pretesting showed that the translated version was sufficiently easy to understand. Internal consistency for the positioning subscale (28 items, Cronbach's α = 0.70) and feeding subscale (15 items, Cronbach's α = 0.70) was good. Mean scores for the positioning subscale for caregivers (mean: 17.1 ± 3.9), medical students (mean: 18.9 ± 3.1), and doctors (mean 21.5 ± 2.2) were significantly different (F = 5.28, P ' = 0.011). Mean scores for the feeding subscale for caregivers (mean 13.1 ± 2.5), medical students (mean 16.1 ± 1.9), and doctors (mean 16.1 ± 2.4) also differed significantly (F = 6.217, P = 0.006). Conclusions: CKQ-My has good internal consistency and construct validity for the subscales measuring stroke caregivers' knowledge about positioning and feeding of stroke patients. It has potential as an assessment of effectiveness of caregiver training and for future studies on long-term stroke outcomes in Malaysia.

Introduction: Stroke survivors are commonly at risk of functional decline following discharge from rehabilitation, which increase their susceptibility to falls, dependency in activities of daily living and emotional disturbances. To combat these, continued therapy is important. Home-based therapy (HBT) has been shown to be useful in maintaining functional performance and quality of life of chronic stroke survivors. However, evidence on its effectiveness remains limited, while no studies are available to date which report the benefit of HBT on stroke survivors self-efficacy and emotional status. Therefore, this study aims to assess the effectiveness of post-discharge HBT in comparison to usual practice on functional outcome (mobility and gait speed), self-efficacy and anxiety level among stroke survivors. Methods: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are HBT (experimental group) and usual practice (UP) (control group). Based on sample size calculation using GPower, a total number of 42 participants will be recruited and allocated into either the HBT or the UP group. Participants in HBT group will receive a set of structured exercise therapy consisting of progressive strengthening, balance and task-related exercises. While participants in UP group will receive a usual “intervention” practised by rehabilitation professional prior to discharging stroke patients from their care. Both groups are advised to perform the given interventions for 3 times per week for 12 weeks under the supervision of their caregiver. Outcomes of interventions will be measured using timed up and go test (for mobility), ten-meter walk test (for gait speed), stroke self-efficacy questionnaire (for self-efficacy) and hospital anxiety and depression scale (for anxiety level). All data will be analyzed using descriptive and inferential statistics. Discussion: This study will provide the information on the effectiveness of HBT in comparison to UP among stroke population who are discharged from rehabilitation. Findings from the study will enable rehabilitation professionals to design effective discharge care plan for stroke survivors in combating functional decline when no longer receiving hospital-based therapy. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12619001182189 (last updated 22/11/2019).

Impairment of cognitive and working memory after stroke was common. Vascular dementia (VaD) was a prevalent type of dementia that was caused by an impaired blood supply to the brain because of a series of small strokes. Electroencephalogram (EEG) gives information about brain status and activity, so it had a lot of potential to be used in diagnosing people with dementia. Since the EEG signal is extremely non-linear and non-stationary data, traditional Fourier analysis such as Fast Fourier Transform (FFT) that broadens sinusoidal signals cannot describe the amplitude contribution of each frequency value in specific time. Meanwhile, Hilbert Huang Transform (HHT) was based on the characteristic local time scale of the signal, it can efficiently obtain instantaneous frequency and instantaneous amplitude for nonstationary and nonlinear data. In this paper, HHT was employed as feature extraction method to extract the energy features of frequency bands from post stroke patients and healthy subjects. The extracted features were fed into extreme learning machine (ELM) for classifying post stroke patient with VaD and healthy subjects. The results of classification accuracy using HHT as feature extractor and FFT as feature extractor were compared. The mean accuracy of classification using HHT was 59.14%, respectively, while mean accuracy of classification using FFT was 94.4%, respectively, in classifying post stroke patient with VaD and healthy subjects.

Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients’ characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p

AIM To assess impacts of tooth loss, preferences for tooth replacement, and relationship between impacts of tooth loss and number of missing teeth. METHODS This is a descriptive cross-sectional survey involving a convenient sample of 244 patients attending a primary health centre and dental clinic at a public university. The respondents completed self-administrated questionnaires on personal background, status of tooth replacement, impacts of tooth loss using a 12-items modified Geriatric Oral Health Assessment Index (GOHAI), and preferences for tooth replacement. A dental examination was done to determine number of missing teeth RESULTS The mean age of the respondents was 56.2 years (S.D. 8.1). The mean number of missing teeth was 8.3 (S.D. 7.3); 62.7% had at least 20 natural teeth. Majority (62.3%) were not wearing dental prosthesis. Mean GOHAI score was 16.3 (S.D. 4.8). 66.0% experienced difficulty in biting some food, 59.4% worried about oral health and 57.8% experienced discomfort when eating. Dental implants were the most preferred replacement option (38.9%). GOHAI scores were not related to number of missing teeth (Pearson’s r=-0.01, p=0.868). CONCLUSIONS Tooth loss and use of dental prosthesis had some impacts on quality of life although impacts were not high.

Electroencephalography (EEG) monitoring is known to be technically feasible and possibly clinically relevant to determine patients with acute ischaemic hemispheric stroke. The EEG is a very useful tool in understanding neurological dysfunction of stroke and likely improving the treatment and rehabilitation. The traditional method for diagnosing with EEG is mainly based on conventional Fast Fourier Transform (FFT). FFT is known to be limited to linear and stationary signal processing. Previously, a technique known as Brain Symmetry Index (BSI) has been proposed to determine the index value for asymmetry of blood flow in right and left brain hemispheres. The estimated index between stroke patient and healthy person ranges between zero and one. Similarly, the existing standard BSI limit the frequency band until 25Hz to eliminate EMG artifact, but at higher frequency band some useful information can also be represented. Hence, highlighting the limitation of FFT in providing the coefficient to calculate BSI index. In this study, we employed the Hilbert Huang Transform (HHT) to extract important feature for this research to use as coefficient in calculating the BSI index for stroke patients with multifocal infarction and healthy individuals. The proposed BSI-HHT spectral analysis conducted in this research was compared with several existing BSI techniques. In order to validate the performance of BSI-HHT, we conducted two experiments 1) 1-25Hz and 2) 1-64Hz for both patients and healthy individuals. The proposed technique offers constant BSI index for two cases and providing better resolution results in determining the index as compared to the existing BSI techniques

Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres. Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems. Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services. No.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Electroencephalography (EEG) monitoring is known to be technically feasible and possibly clinically relevant to determine patients with acute ischemic hemispheric stroke. The EEG is very useful tool in understanding neurological dysfunction of stroke plausible improving the treatment and rehabilitation. Most of the existing techniques to diagnose stroke from the EEG signal is mainly based on Fourier Transform (FT). For instance, the Brain Symmetry Index (BSI) employed Fast Fourier Transform (FFT) as coefficients to measure symmetrical of blood flow between left and right brain hemisphere. The symmetrical index ranges between zero and one where one indicates the highest asymmetrical of blood flow. It is known that the conventional FFT has limitation in analyzing non-linear and non-stationary signal. Therefore, the existing BSI and its variations may also suffer from this transformation properties. In this study, we propose BSI based on Hilbert Huang Transform (HHT) which defined as BSI-HHT. HHT is a way to decompose a signal into so-called intrinsic mode functions (IMF) along with a trend, and obtain instantaneous frequency data. The HHT will be used as coefficients instead off FFT in calculating the BSI index. An experiment to validate the performance of BSI-HHT is conducted in this study as to compare with the existing BSI technique. The EEG signal of Middle Cerebral Artery (MCA) subjects and healthy subjects are used for this investigation. The proposed BSI-HHT has offered better interpretation as it correlates to the stimulation procedure on the gathered data especially at specific frequency band. Also, through the analysis, the HHT coefficient is able to capture the non-stationary and non-linear of the interest electrode.

Background Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services. Methods A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached. Results Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support. Conclusions Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.