Background. Non-attendance is common in primary care and previous studies have reported that reminders were useful in reducing broken appointments. Objective. To determine the effectiveness of a text messaging reminder in improving attendance in primary care. Design. Multicentre three-arm randomized controlled trial. Setting. Seven primary care clinics in Malaysia. Participants. Patients (or their caregivers) who required follow-up at the clinics between 48 hours and 3 months from the recruitment date. Interventions. Two intervention arms consisted of text messaging and mobile phone reminders 24–48 hours prior to scheduled appointments. Control group did not receive any intervention. Outcome measures. Attendance rates and costs of interventions. Results. A total of 993 participants were eligible for analysis. Attendance rates of control, text messaging and mobile phone reminder groups were 48.1, 59.0 and 59.6%, respectively. The attendance rate of the text messaging reminder group was significantly higher compared with that of the control group (odds ratio 1.59, 95% confidence interval 1.17 to 2.17, P = 0.005). There was no statistically significant difference in attendance rates between text messaging and mobile phone reminder groups. The cost of text messaging reminder (RM 0.45 per attendance) was lower than mobile phone reminder (RM 0.82 per attendance). Conclusions. Text messaging reminder system was effective in improving attendance rate in primary care. It was more cost-effective compared with the mobile phone reminder.

Previous studies report various degrees of agreement between self-perceived competence and objectively measured competence in medical students. There is still a paucity of evidence on how the two correlate in the field of Evidence Based Medicine (EBM). We undertook a cross-sectional study to evaluate the self-perceived competence in EBM of senior medical students in Malaysia, and assessed its correlation to their objectively measured competence in EBM.

Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by Staphylococcus aureus. The prevalence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment. This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012), contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles. We selected randomised controlled trials (RCTs) and quasi‐RCTs comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis. Two review authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author. Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic. There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high‐quality, double‐blinded RCTs to determine whether antibiotics should be used in this common postpartum condition. Antibióticos para mastite em lactantes A mastite pode ser causada por erros de posicionamento do bebê no seio materno ou amamentação restrita. A mastite infecciosa é geralmente causada pelo Staphylococcus aureus. Até 33 % das lactantes podem ter mastite. O tratamento habitual da mastite se baseia no esvaziamento do leite, analgésicos e antibióticos. O objetivo desta revisão foi avaliar a efetividade da antibioticoterapia no alívio dos sintomas de lactantes com mastite, com ou sem confirmação laboratorial do diagnóstico. Fizemos buscas na base de dados eletrônica no Cochrane Pregnancy and Childbirth Group Trials Register (em 30 de Setembro de 2012). Entramos em contato com pesquisadores e outros especialistas da área, buscando identificar estudos não publicados. A busca foi complementada pela análise das listas de referências bibliográficas dos artigos encontrados. Foram incluídos nesta revisão apenas ensaios clínicos controlados e randomizados (ECR) ou quasi ‐randomizados que compararam a efetividade de diversos esquemas de antibioticoterapia para o tratamento da mastite ou que compararam antibioticoterapia versus outros tipos de tratamento. Dois revisores avaliaram de forma independente a qualidade dos estudos e extraíram os dados. Um terceiro revisor foi consultado em caso de discordância entre os dois revisores. Dois estudos preencheram os critérios de inclusão. Um estudo com pequena casuística (n = 25) comparou Amoxacilina com Cefradina e não encontrou diferença significante entre esses dois antibióticos para o alívio dos sintomas ou na formação de abscessos. Outro estudo mais antigo, comparou o uso exclusivo do esvaziamento mamário versus antibioticoterapia mais esvaziamento, versus nenhum tratamento. Segundo esse estudo, a duração dos sintomas foi menor nas mulheres que receberam antibióticos; porém esse estudo teve falhas no seu desenho. As evidências são insuficientes para avaliar a efetividade da antibioticoterapia no tratamento da mastite puerperal. São necessários mais ensaios clínicos randomizados duplo‐cego e de boa qualidade antes que possam ser feitas recomendações quanto à prescrição, ou não, de antibióticos para o tratamento da mastite puerperal.

Non-attendance results in administrative problems and disruption in patient care. Several interventions have been used to reduce non-attendance, with varying degree of success. A relatively new intervention, text messaging, has been shown to be as effective as telephone reminders in reducing non-attendance. However, no study has looked specifically at using text messaging reminders to reduce non-attendance in chronic disease care. To determine if text messaging would be effective in reducing non-attendance in patients on long-term followup, compared with telephone reminders and no reminder. A randomised controlled trial with three arms: text messaging reminder, telephone reminder, and control. Two primary care clinics in Malaysia. A total of 931 subjects who had been on at least 6 months of follow-up were randomised into the three groups. Demographic variables were recorded at the first visit. In the intervention arms, a reminder was sent 24–48 hours prior to the appointment. Non-attendance rate was documented at the second visit. Non-attenders were defined as those who did not attend, attended early, or attended late without rescheduling their appointment. Attenders were defined as participants who had turned up for their scheduled appointment and those who had changed or cancelled their appointment with notification. The non-attendance rates in the text messaging group (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.41 to 0.93, P = 0.020) and the telephone reminder group (OR = 0.53, 95% CI = 0.35 to 0.81), P = 0.003) were significantly lower than the control group. The absolute non-attendance rate for telephone reminders was lower by 2% compared to the text messaging group. This difference was not found to be statistically significant (P = 0.505). Text messaging was found to be as effective as telephone reminder in reducing non-attendance in patients who required long-term follow-up for their chronic illnesses in this study. It could be used as an alternative to conventional reminder systems.