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Centre for Clinical Epidemiology (CCE)

1.0 About Us

The Centre for Clinical Epidemiology (CCE) at the Institute for Clinical Research (ICR) undertakes research on the prevention, aetiology, diagnosis, prognosis and treatment of disease. CCE employs a variety of research methodologies in the conduct of population-based research with potential clinical and public health applications, in line with national research priority areas. CCE also provides support in planning, designing, and conducting research in many disease areas, particularly non-communicable diseases.

The vision of CCE is to become the leading centre of patient-oriented research in providing evidence that underpin national health policies. Our mission is to contribute evidence through epidemiological research to bridge the gaps between clinical practice and health policy in the best interest of patient care.

2.0 Research

2.0.1 Research Area

CCE has a strong focus on studies which can provide evidence that informs decision-making of patients, healthcare providers and policymakers. Our current research areas include:

Cancer Research
During the 58th World Health Assembly in 2005, the Member States were called upon to intensify action against cancer by developing and reinforcing cancer control program through four components, namely prevention, early detection, diagnosis & treatment and palliative care. The cancer research conducted in CCE are in line with these key domains of the National Cancer Control Program to provide useful information and evidence to the key stakeholders.
Palliative Care Research
Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness. Many patients who were diagnosed with advanced stages of disease are likely to suffer physically and psychologically in view of limited resources for early diagnosis and treatment. To provide optimum care for this group of patients, palliative care is very important. However, this area is under researched in Malaysia. In line with the concept of Universal Health Coverage, our research aims to explore both epidemiological and clinical aspects of palliative care, to push forward the concept of “leave no one behind” within the scope of palliative care services.
Aging Research
According to published statistics, Malaysia is at risk of becoming an “ageing population”. Malaysia statistics shows that those aged 60 years and above stood at 7.9% in 2010 and projected to reach 15.3% by 2030. Every person in the world should have the opportunity to live a long and healthy life. Healthy ageing is a process of developing and maintaining the functional ability that enables wellbeing in older age. By understanding ageing as a process rather than a disease, our research aims to create environments and opportunities that enable people to be able to do what they value throughout their lives.
Dengue Research
Dengue infection has been recognized as the fastest spreading mosquito-borne viral disease by WHO. Malaysia is hyper-endemic with dengue virus and the number of cases has been escalating over the years. Our research projects focus on dengue epidemiology and its health burden, with the aim to provide evidence to guide dengue control and prevention program by MOH Malaysia.
COVID-19 Research
The COVID-19 pandemic in Malaysia is part of the ongoing worldwide pandemic of coronavirus disease, with the first case being detected in the country on 24 January 2020. Since then, the number of cases have been constantly on the rise. The COVID-19 pandemic does not only cause mortality among cases directly related to the disease, but it has led to other multifaceted effects as well. The COVID-19 pandemic has resulted in collateral damage to other sectors, notably the economic and healthcare industry. At CCE, we aim to focus on the impact of COVID-19 towards the healthcare industry in Malaysia. At this moment, there is no cure for COVID-19 infection. The prospects of a suitable vaccine seems to be the way forward in overcoming the COVID-19 pandemic. One of the determining factors for the success of a vaccination program is achievement of herd immunity. Hence, it is important to obtain public acceptance in the vaccination program. While numerous pharmaceutical companies are looking into the invention of the vaccine through clinical trials, CCE also works on research to investigate COVID-19 vaccine acceptance level and its associated factors among Malaysian public.

2.0.2 Ongoing Research

Cancer Research

Detection, Diagnosis and Cancer Treatment Timeline in Malaysia (DEDICATE).

  • The objective of this study is to study the timeline from presentation to diagnosis and treatment of cancer among breast, colorectal, cervical and nasopharyngeal cancer patients. This is a multicentre cross-sectional study collaborated with the Ministry of Health (MOH) hospitals (Clinicians), Non-Communicable Disease (NCD) division at MOH, and Cancer Research Malaysia (NGO). The study finding would guide improvement of service delivery in reducing premature cancer mortality in Malaysia.

Development of a Needs Evaluation Questionnaire in Malaysians Living with Colorectal Cancer.

  • The aim of this study is to develop a needs assessment questionnaire, which is specific to multiethnic colorectal cancer survivors living in Malaysia. The study population for validation comprises multiethnic colorectal cancer patients attending follow-up visits in several oncology referral centres in Klang Valley. This is a collaborative study with University Malaya Medical Centre, Hospital Kuala Lumpur and National Cancer Institute and Subang Jaya Medical Centre. This study will quantify the different needs of patients with colorectal cancer, as well as detailing aspects of needs that will require intervention from different stakeholders.

Development of a Needs Evaluation Questionnaire in Malaysian Women Living with Breast Cancer.

  • This study is going to develop and validate a needs assessment questionnaire for women living with breast cancer in a multiethnic Asian setting. The study population for validation comprises multiethnic breast cancer patients attending follow-up visits in several oncology referral centres in Klang Valley. This study will aid in identifying and quantifying the different needs of Malaysian patients with breast cancer, which in turn will aid planning of survivorship care to optimizing the life of women living with breast cancer

A Retrospective Study on Evaluating Pattern of Presentation, Treatment Management and Outcome of Patients with Breast Cancer in a Main Tertiary Centre.

  • The study planned to determine the outcome of breast cancer and the factors associated with its prognosis. All diagnosed or referred breast cancer patients presenting to the oncology or surgical department of Hospital Kuala Lumpur from January 2008 to December 2015 were enrolled into this retrospective cohort study. This is a collaborative study with Hospital Kuala Lumpur. The study results will help in planning and management by the clinicians to improve the prognosis of breast cancer patients.

Burden of Cancers Attributable to Modifiable Risk Factors in Malaysia.

  • The study aims to identify the proportion of cancers in Malaysia that are attributable to the modifiable risk factors of obesity, physical activity, tobacco smoking, alcohol intake, and to estimate the number of cancer cases that could be prevented if the exposure to modifiable risk factor is reduced. This is a secondary data analysis on nationally representative data to estimate the burden of cancers due to the modifiable risk factors (obesity, physical activity, tobacco smoking, alcohol intake) using Population Attributable Approach (PAF). The study will help policymakers to set priorities for relevant health interventions.
Palliative Care Research

Patterns of Place of Death: A review of palliative care patients in Palliative Care Unit, Hospital Selayang.

  • This study reviewed the patterns of preferred and actual place of death among palliative care patients who were admitted to Palliative Care Unit, Hospital Selayang from 1 January 2015 to 31 December 2017. Patients’ sociodemographic, clinical characteristics and preferred place of death information were extracted. The patients were matched with the National Registration Department’s death registry to identify the actual place of death. Any incongruence between preferred and actual place of death is categorized as a mismatched place of death. The factors associated with the preferred and actual place of death were being studied. This is a collaborative study with the Palliative Care Team at Hospital Selayang. This study would support the palliative care team to improve their services through strategic planning and development of comprehensive and patient-oriented guidelines and policies.

Epidemiology of Patients Referred to Palliative Care Services: Perspective from the Hospis Malaysia Setting.

  • The aim of the study is to study the epidemiology of patients referred to domiciliary palliative care service in Hospis Malaysia. This is a retrospective review of palliative care patients who received domiciliary palliative care under Hospis Malaysia, with first referral during the period of 1 January 2017 to 31 December 2019 with corresponding records captured within the electronic medical records. The patients’ demographic, clinical, pharmacology and outcome data will be extracted from the system and subsequently analysed. The current practices and challenges during domiciliary palliative care services which are faced by Hospis Malaysia can be used as a reference in the future planning of expanding palliative care services to the community level.
Aging Research

Galantamine for Alzheimer’s Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.

  • This systematic review is to ensure that the best available evidence regarding the effect of galantamine in Alzheimer’s disease and mild cognitive impairment are collated. This is a Cochrane systematic review and meta-analysis of double-blind, parallel-group, randomised controlled trials that compared galantamine with placebo for a treatment duration of greater than 4 weeks in patients with dementia due to Alzheimer’s disease or mild cognitive impairment. This is a collaborative study with the University of Sydney, Australia and University of Southern California, USA. This systematic review will serve as an evidence base for clinical practice guidelines for the management of Alzheimer’s disease and mild cognitive impairment. In particular, this review will provide a scientific basis for the use of galantamine in special clinical populations and long-term effects on cognition, function, and behaviour.

Withdrawal or Continuation of Cholinesterase Inhibitors and/or Memantine in Patients with Dementia.

  • This is a Cochrane systematic review and meta-analysis of randomised controlled trials which compared withdrawal of cholinesterase inhibitor and/or memantine with continuation of cholinesterase inhibitor and/or memantine in patients with dementia. This is a collaborative study with Queen’s University Belfast, United Kingdom, Monash Aging Research Centre, Australia and The University of Sydney, Australia. This systematic review will serve as an evidence base to guide clinicians in deciding whether and when to de-prescribe cholinesterase inhibitors or memantine in patients with dementia.
COVID-19 Research

Acceptance and Perception of the COVID-19 Vaccination in the General Population of Malaysia.

  • This research studied the factors affecting the perception and acceptance of the COVID-19 vaccination in the general population of Malaysia. This is a cross sectional study involving the general Malaysian public conducted from July – August 2020. The study was conducted using a web based electronic Self-Administered Questionnaire (SAQ) utilizing the Research Electronic Data Capture (REDCap). The study result will provide some insight to policy makers about public acceptance towards COVID-19 vaccine and its associated factors.

Temporal Trends in the Rate of Hospital Admissions, Outpatient Visits, and Procedures Performed in Malaysian Healthcare Facilities during the COVID-19 Pandemic (TEMPO-19).

  • The objective of this study is to investigate the rate of hospital admissions, outpatient visits, and procedures performed in Malaysian public and private healthcare facilities during the COVID-19 pandemic. This is an interrupted time series study based on fully de-identified data extracted from the Malaysian Health Data Warehouse (MyHDW), clinical registries, and palliative care service databases. Medical and administrative data from 2015 to 2021 will be collected. This is a collaborative study with the Institute for Health Services Research (IHSR), the palliative care team at Ministry of Health Malaysia, the ophthalmology team at Selayang Hospital and the cardiovascular team at Queen Elizabeth II Hospital. Nationwide population-based data on hospital admissions during the COVID-19 pandemic can provide valuable information on the secondary impact of the pandemic on the healthcare system. Findings of this study will enable policymakers to understand how crisis affects the delivery of healthcare services.

COVID-19 Pandemic: An Analysis of Its Impact on the Provision of Routine Clinical Care within the Malaysian (IMPROVISE).

  • This study aims to determine the impact of the COVID-19 pandemic on the provision of routine healthcare services in Malaysia from the perspective of healthcare workers and the general public. This is a cross-sectional web-based survey among Malaysian healthcare workers (i.e. doctors, dentists and pharmacists) and the general public. Findings will enable policy makers to plan out measures to dampen the negative impacts of COVID-19 pandemic on healthcare service delivery.

COVID-19 Pandemic: A Situational Analysis on Clinic Appointment System in the New Normal within the Malaysian Healthcare System (STANCE).

  • The objective of the study is to study the views and agreement of the general public towards having a staggered clinic appointment system when adapting to the new normal resulting from the COVID-19 pandemic in Malaysia. This is a cross-sectional study among Malaysian public conducted by using a web-based electronic questionnaire [REDCap] from July to December 2020. This study will enable policy makers to better plan and implement new policy measures to facilitate the transition of Malaysian healthcare system towards its new norm.

2.0.3 Completed Research

A. List of Research Published in Year 2019 – 2020

COVID-19 Research.
  • Serology Surveillance of Anti-SARS-Cov-2 Antibodies among Asymptomatic Healthcare Workers in Malaysian Healthcare Facilities Designated for COVID-19 Care (preprint).
Cancer Research.
  • Working After Cancer: In-Depth Perspectives from a Setting with Limited Employment Protection Policies.
  • Breaking News of Cancer Diagnosis: A Qualitative Study on the Experiences and Emotional Needs of Patients With Cancer in a Multiethnic Asian Setting.
  • The Association Between Methods of Biopsy and Survival Following Breast Cancer: A Hospital Registry Based Cohort Study.
  • Survival of Patients With Advanced and Recurrent Ovarian Cancer Treated Using Integrative Medicine in Malaysia: A Case Series.
  • Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action.
Palliative Care Research.
  • Adult Palliative Care 2004–2030 Population Study: Estimates and Projections in Malaysia.
Dengue and Zika Research.
  • Feasibility of Case-Control and Test-Negative Designs to Evaluate Dengue Vaccine Effectiveness in Malaysia.
  • Zika Virus Infection In Malaysia: An Epidemiological, Clinical and Virological Analysis.
  • Health Facility Use by Dengue Patients in the Klang Valley, Malaysia: A Secondary Analysis of Dengue Surveillance Data.
Obstetrics and Gynecology Research.
  • Caesarean Section Rates from Malaysian Tertiary Hospitals using Robson’s 10-Group Classification.
  • Is Selective Mediolateral Episiotomy Protective Against Spontaneous Perineal Trauma and OASIS in Malaysian Tertiary Hospitals? A Cross Sectional Study from the National Obstetrics Registry.
  • Effectiveness of a Pharmacist-Led Quality Improvement Program to Reduce Medication Errors During Hospital Discharge.
  • Tuberculosis and Associated Factors among Type 2 Diabetic Patients In Perak: A Case Control Study.
  • The Effects of Enhanced Primary Healthcare Interventions on Primary Care Providers’ Job Satisfaction.

B. List of Posters Produced in Year 2020

Posters Produced
  • Prognostic Factors for Mortality Among Early Stage C Breast Cancer Patients.
  • Factors Associated with Cardiovascular Risk Factors Among Breast Cancer Patients.
  • Burdens of Cancer Attributable to Modifiable Risk Factors in Malaysia.
  • Where Do Our Palliative Care Patients Die?
  • Malaysian’s Perception on Who Should Get Covid-19 Vaccination First?
  • Factors Influencing Acceptance of COVID-19 Vaccination Among Malaysian Adults.

For full abstract and research findings of published research and posters, refer to the document link:

Link: https://cutt.ly/PublicationsCCE

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3.0 Services

3.0.1 Research Consultation Clinic

Research consultation clinic [RCC] is a free consultation service provided by experienced researchers from CCE to assist MOH investigators/researchers in their clinical research. The RCC usually entertain the following requests:
  • Brainstorming
  • Proposal development
  • Research methodology
  • Data management and care report form design
  • Statistical analysis
  • Interpretation and output presentation
Training and Professional Development
As an offshoot of our research activities, CCE frequently provides training especially for investigators participating in research and health professionals who have an interest in clinical research. The training courses provided by CCE are often developed and organized in collaboration with other relevant agencies such as professional societies, academic institutions, etc.

4.0 Organization Chart (CEU)


Contact for Enquiries
Email : cce.icrmalaysia@gmail.com
Tel : +603 3362 7700 / 8807
Fax : +603 3362 7701

Center for Clinical Epidemiology (CCE)
Institute for Clinical Research (ICR)
Block B4, National Institute of Health Complex (NIH)
1, Jalan Setia Murni, U13/52, Seksyen U13
40170 Shah Alam, Selangor, Malaysia