Displaying publications 1 - 20 of 58 in total

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  1. Lee YY
    PMID: 25705618 DOI: 10.3389/fmed.2014.00005
    Constipation and fecal incontinence (FI) are common complaints predominantly affecting the elderly and women. They are associated with significant morbidity and high healthcare costs. The causes are often multi-factorial and overlapping. With the advent of new technologies, we have a better understanding of their underlying pathophysiology which may involve disruption at any levels along the gut-brain-microbiota axis. Initial approach to management should always be the exclusion of secondary causes. Mild symptoms can be approached with conservative measures that may include dietary modifications, exercise, and medications. New prokinetics (e.g., prucalopride) and secretagogues (e.g., lubiprostone and linaclotide) are effective and safe in constipation. Biofeedback is the treatment of choice for dyssynergic defecation. Refractory constipation may respond to neuromodulation therapy with colectomy as the last resort especially for slow-transit constipation of neuropathic origin. Likewise, in refractory FI, less invasive approach can be tried first before progressing to more invasive surgical approach. Injectable bulking agents, sacral nerve stimulation, and SECCA procedure have modest efficacy but safe and less invasive. Surgery has equivocal efficacy but there are promising new techniques including dynamic graciloplasty, artificial bowel sphincter, and magnetic anal sphincter. Despite being challenging, there are no short of alternatives in our toolbox for the management of constipation and FI.
  2. Wattanapisit A, Poomiphak Na Nongkhai M, Hemarachatanon P, Huntula S, Amornsriwatanakul A, Paratthakonkun C, et al.
    Front Med (Lausanne), 2021;8:704403.
    PMID: 34422861 DOI: 10.3389/fmed.2021.704403
  3. Choi T, Sarkar M, Bonham M, Brock T, Brooks IA, Diug B, et al.
    Front Med (Lausanne), 2023;10:1146832.
    PMID: 37849488 DOI: 10.3389/fmed.2023.1146832
    INTRODUCTION/BACKGROUND: Course evaluation in health education is a common practice yet few comprehensive evaluations of health education exist that measure the impact and outcomes these programs have on developing health graduate capabilities.

    AIM/OBJECTIVES: To explore how curricula contribute to health graduate capabilities and what factors contribute to the development of these capabilities.

    METHODS: Using contribution analysis evaluation, a six-step iterative process, key stakeholders in the six selected courses were engaged in an iterative theory-driven evaluation. The researchers collectively developed a postulated theory-of-change. Then evidence from existing relevant documents were extracted using documentary analysis. Collated findings were presented to academic staff, industry representatives and graduates, where additional data was sought through focus group discussions - one for each discipline. The focus group data were used to validate the theory-of-change. Data analysis was conducted iteratively, refining the theory of change from one course to the next.

    RESULTS: The complexity in teaching and learning, contributed by human, organizational and curriculum factors was highlighted. Advances in knowledge, skills, attitudes and graduate capabilities are non-linear and integrated into curriculum. Work integrated learning significantly contributes to knowledge consolidation and forming professional identities for health professional courses. Workplace culture and educators' passion impact on the quality of teaching and learning yet are rarely considered as evidence of impact.

    DISCUSSION: Capturing the episodic and contextual learning moments is important to describe success and for reflection for improvement. Evidence of impact of elements of courses on future graduate capabilities was limited with the focus of evaluation data on satisfaction.

    CONCLUSION: Contribution analysis has been a useful evaluation method to explore the complexity of the factors in learning and teaching that influence graduate capabilities in health-related courses.

  4. Rajiah K, Maharajan MK, Ramaya H, Wan Ab Rahman WNA
    Front Med (Lausanne), 2021;8:617147.
    PMID: 34368172 DOI: 10.3389/fmed.2021.617147
    Introduction: Administration of psychotropic pro re nata (PRN) medications is influenced by diverse factors such as legal use of PRN medications, the attitude of patients, personal bias, and stigma toward such medication use. While PRN prescriptions increase the efficiency of care and encourage patients to participate in self-care, the use of psychotropic PRN medications by outpatients has raised concerns about its risks of harm, especially for the outpatients. This study explored the use of psychotropic PRN medications by patients attending the outpatient clinic in a hospital. Methods: Qualitative in-depth interviews were conducted. Purposeful sampling was done to achieve cases with enriched information. Participants were chosen regardless of their ethnicity and were selected using the database and patient records in the clinic. Patients 18 years of age prescribed PRN psychotropic medications attending outpatient clinics in a hospital were included. Vulnerable patients (e.g., pregnant ladies, prisoners, cognitively impaired individual, AIDS/HIV subjects, and terminally ill subjects) were excluded. Results: This study revealed the patients' perspectives and experiences on self-management of psychotropic PRN medications. The themes that emerged were clustered as education and background, knowledge on psychotropic medications, frequency of medication intake, underuse of medication, the overdose of medication, side effects concern, source of information, and personal experience. Conclusions: Patients' understanding of medication, inappropriate medication use, cues to action, and use of alternatives are the factors that affected the self-management of psychotropic PRN medications by the patients.
  5. Rehman IU, Wu DB, Pauline Lai SM, Palanisamy UD, Lim SK, Khan TM
    PMID: 29167792 DOI: 10.3389/fmed.2017.00189
    Introduction: Several tools have been developed to assess the severity of pruritus. In Malaysia, no tool has been validated to assess pruritus in patients with chronic kidney disease (CKD). Therefore, the aim of our study was to validate the Malay 5D itching scale (M5D-IS) among patients with CKD in Malaysia.

    Method: The English version of the 5D-IS was translated into Malay according to International Guidelines. Face and content validity was determined by an expert panel and pilot tested in patients with end-stage renal disease (ESRD). The M5D-IS was then validated in a tertiary hospital in Malaysia from May to June 2016. We recruited patients with (i.e., patients with ESRD) and without pruritus (i.e., patients with stage 1-3 CKD) (to determine if the M5D-IS could discriminate between the two groups), and administered the M5D-IS at baseline and 2 weeks later. Exploratory factor analysis was used to examine the construct validity. Internal consistency was assessed using Cronbach's alpha and intraclass correlation coefficient was calculated to assess the reliability of the instrument.

    Results: A total of 70 participants were recruited (response rate = 100%). The majority were males (51.4%) and Malay (67.1%). Exploratory factor analysis revealed that the 5D-IS had 2-factor loadings: "daily routine activity" and "pattern of itching," which explained 77.7% of the variance. The overall score of the M5D-IS, as well as for each domain, was significantly worse in participants with pruritus (9.83 ± 0.35), compared to those without pruritus (5.51 ± 0.93, p 

  6. Alzain AF, Elhussein N, Hamd ZY, Fadulelmulla IA, Omer AM, Alotaibi A, et al.
    Front Med (Lausanne), 2023;10:1243014.
    PMID: 38486825 DOI: 10.3389/fmed.2023.1243014
    BACKGROUND: Volunteering is a beneficial activity with a wide range of positive outcomes, from the individual to the communal level. In many ways, volunteering has a positive impact on the development of a volunteer's personality and experience. This study aimed to evaluate the impact of health volunteering on improving the self-skills and practical capacities of students in the western region of the Kingdom of Saudi Arabia.

    MATERIALS AND METHODS: The study was a descriptive cross-sectional electronic web-based survey that was submitted on a web-based questionnaire; 183 students answered the survey, and then, the data were analyzed using SPSS.

    RESULTS: This study shows that 95.6% of participants agree and strongly agree that the health volunteering experience was useful, 2.7% of the participants neither agree nor disagree, and 1.6% disagree and strongly disagree. Regarding the distribution of the participants on skills learned from volunteering experience, the largest proportion of student (36.1%) volunteers in the health sector acquired communication skills and the smallest proportion of student (14.8%) volunteers in the acquired time management skills. Regarding the disadvantages, 81.4% of the participants do not think there were any disadvantages to their previous health volunteering experience, while only 18.6% of them think there were any disadvantages to their previous health volunteering experience. Additionally, the study found that the type of the sector affects the skills acquired from health volunteering.

    CONCLUSION: Research revealed that the majority considered volunteering a great experience. Volunteering increased the self-skills and practical capacities of radiology students, which proved the hypothesis.

  7. Gharaibeh M, Alfwares AA, Elobeid E, Khasawneh R, Rousan L, El-Heis M, et al.
    Front Med (Lausanne), 2023;10:1276434.
    PMID: 38076239 DOI: 10.3389/fmed.2023.1276434
    AIMS: To assess the diagnostic performance of digital breast tomosynthesis (DBT) in older women across varying breast densities and to compare its effectiveness for cancer detection with 2D mammography and ultrasound (U/S) for different breast density categories. Furthermore, our study aimed to predict the potential reduction in unnecessary additional examinations among older women due to DBT.

    METHODS: This study encompassed a cohort of 224 older women. Each participant underwent both 2D mammography and digital breast tomosynthesis examinations. Supplementary views were conducted when necessary, including spot compression and magnification, ultrasound, and recommended biopsies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated for 2D mammography, DBT, and ultrasound. The impact of DBT on diminishing the need for supplementary imaging procedures was predicted through binary logistic regression.

    RESULTS: In dense breast tissue, DBT exhibited notably heightened sensitivity and NPV for lesion detection compared to non-dense breasts (61.9% vs. 49.3%, p  0.05) between DBT and the four dependent variables.

    CONCLUSION: Our findings indicate that among older women, DBT does not significantly decrease the requirement for further medical examinations.

  8. Goh CH, Muslimah Y, Ng SC, Subramanian P, Tan MP
    PMID: 25593906 DOI: 10.3389/fmed.2014.00032
    Manual transfer of elderly patients remains commonplace in many developing countries because the use of lifting equipment, such as hoists, is often considered unaffordable luxuries. The aim of this study was, therefore, to evaluate the usage and potential benefits of a low-cost, mechanical turning transfer device among elderly patients and their caregivers on a geriatric ward in a developing country in South East Asia. Fifty-six inpatients, aged 66-92 years, on a geriatric ward, and their caregivers were recruited. Participants were asked to transfer from bed-to-chair transfer with manual assistance, and the task was repeated using the Self-standing Turning Transfer Device (STurDi). The time taken to perform manual transfers and STurDi-assisted transfers was recorded. Physical strain was assessed using the perceived physical stress-rating tool for caregivers with and without the use of the device. User satisfaction was evaluated using the usefulness, satisfaction, and ease of use questionnaire. There was a significant reduction in transfer-time with manual transfers compared to STurDi-assisted transfers [mean (SD) = 48.39 (13.98) vs. 36.23 (10.96); p ≤ 0.001]. The physical stress rating was significantly lower in STurDi-aided transfers compared to manual transfers, shoulder [median (interquartile range) = 0 (1) vs. 4 (3); p = 0.001], upper back [0 (0) vs. 5 (4); p = 0.001], lower back [0 (1) vs. 5 (3), p = 0.001], whole body [1 (2) vs. 4 (3), p = 0.001], and knee [0 (1) vs. 1 (4), p = 0.001]. In addition, majority of patients and caregivers definitely or strongly agreed that the device was useful, saved time, and was easy to use. We have therefore demonstrated in a setting where manual handling was commonly performed that a low-cost mechanical transfer device reduced caregiver strain and was well received by older patients and caregivers.
  9. Mahli N, Md Zain J, Mahdi SNM, Chih Nie Y, Chian Yong L, Shokri AFA, et al.
    Front Med (Lausanne), 2021;8:677626.
    PMID: 34026801 DOI: 10.3389/fmed.2021.677626
    This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8-41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8-69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.
  10. Norhayati MN, Che Yusof R, Azman YM
    Front Med (Lausanne), 2021;8:783982.
    PMID: 35155467 DOI: 10.3389/fmed.2021.783982
    INTRODUCTION: Vaccination is an essential intervention to curb the coronavirus disease 2019 (COVID-19) pandemic. This review aimed to estimate the pooled proportion of COVID-19 vaccine acceptance worldwide.

    METHODS: A systematic search of the MEDLINE (PubMed) database using "COVID-19," "vaccine" and "acceptance" to obtain original research articles published between 2020 and July 2021. Only studies with full text and that were published in English were included. The Joanna Briggs Institute meta-analysis was used to assess the data quality. The meta-analysis was performed using generic inverse variance with a random-effects model using the Review Manager software.

    RESULTS: A total of 172 studies across 50 countries worldwide were included. Subgroup analyses were performed with regard to vaccine acceptance, regions, population, gender, vaccine effectiveness, and survey time. The pooled proportion of COVID-19 vaccine acceptance was 61% (95% CI: 59, 64). It was higher in Southeast Asia, among healthcare workers, in males, for vaccines with 95% effectiveness, and during the first survey.

    CONCLUSION: COVID-19 vaccine acceptance needs to be increased to achieve herd immunity to protect the population from the disease. It is crucial to enhance public awareness of COVID-19 vaccination and improve access to vaccines.

    SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2021, identifier CRD42021268645.

  11. Aminuddin NA, Sutan R, Mahdy ZA
    Front Med (Lausanne), 2020;7:596405.
    PMID: 33553199 DOI: 10.3389/fmed.2020.596405
    Background: Preeclampsia is a significant cause of maternal and perinatal mortality worldwide. Oxidative stress plays a key role in its pathophysiology, hence antioxidants such as tocotrienol may be preventive against preeclampsia. In 2018, the ISSHP revised the definition of preeclampsia. In accordance with the new definition, we report a secondary data analysis from a clinical trial comparing palm oil vitamin E in the form of tocotrienol-rich fraction (TRF) against placebo, in preventing preeclampsia. Method: A randomized double-blind controlled trial was conducted in 2002-2005 to assess the benefits of TRF in preeclampsia prevention. A total of 299 primigravidae were recruited. The intervention group was supplemented with TRF 100 mg daily in super-olein capsules, whereas the placebo group was prescribed super-olein capsules without TRF, beginning from 12 to 16 gestational weeks until delivery. The primary outcome measure was incidence of preeclampsia. Results: The total incidence of pregnancy induced hypertension (PIH) was 5%, whereas the incidence of preeclampsia was 2.3%. The odds of developing PIH (adjusted OR 0.254; 95% CI: 0.07-0.93; p-value 0.038) and preeclampsia (adjusted OR 0.030; 95% CI: 0.001-0.65; p-value 0.025) were significantly lower in the TRF arm compared to the placebo arm. Conclusion: Antenatal supplementation with palm oil vitamin E in the form of TRF is associated with significant reductions in the incidence of preeclampsia and PIH in a single urban tertiary hospital. Palm oil vitamin E deserves further scrutiny as a potential public health preventive measure against preeclampsia and PIH.
  12. Patel P, Macdonald JC, Boobalan J, Marsden M, Rizzi R, Zenon M, et al.
    Front Med (Lausanne), 2023;10:1275817.
    PMID: 38020129 DOI: 10.3389/fmed.2023.1275817
    The appropriate use of regulatory agilities has the potential to accelerate regulatory review, utilize resources more efficiently and deliver medicines and vaccines more rapidly, all without compromising quality, safety and efficacy. This was clearly demonstrated during the COVID-19 pandemic where regulators and industry rapidly adapted to ensure continued supply of existing critical medicines and review and approve new innovative medicines. In this retrospective study, we analyze the impact of regulatory agilities on the review and approval of Pfizer/BioNTech's BNT162b2 mRNA COVID-19 Vaccine globally using regulatory approval data from 73 country/regional approvals. We report on the critical role of reliance and provide evidence that demonstrates reliance approaches and certain regulatory agilities reduced review times for the COVID-19 vaccine. These findings support the case for more widespread implementation of regulatory agilities and demonstrate the important role of such approaches to improve public health outcomes.
  13. Vimali J, Yong YK, Murugesan A, Vishnupriya K, Ashwin R, Daniel EA, et al.
    Front Med (Lausanne), 2022;9:1019230.
    PMID: 36405584 DOI: 10.3389/fmed.2022.1019230
    Chronic viral infections represent a leading cause of global morbidity and mortality. Chronic HBV, HCV, and HIV infections result in cytokine perturbations that may hold key implications in understanding the complex disease mechanisms driving virus persistence and/or resolution. Here, we determined the levels of various plasma cytokines using a commercial Bio-Plex Luminex cytokine array in chronic HBV (n = 30), HCV (n = 15), and HIV (n = 40) infections and correlated with corresponding plasma viral loads (PVLs) and liver parameters. We observed differential perturbations in cytokine profiles among the study groups. The cytokines levels positively correlated with PVL and liver transaminases. The monocyte-derived cytokines viz., MIP-1β, IL-8, and TNF-α, and Th2 cytokines like IL-4, IL-5, and IL-13 showed a better correlation with liver enzymes as compared to their corresponding PVLs. Our investigation also identified two cytokines viz., IL-5 and IL-7 that inversely correlated with HBV DNA and HIV PVLs, respectively. Regression analysis adjusted for age showed that every increase of IL-5 by one unit was associated with a reduction in HBV PVL by log10 0.4, whereas, every elevation by a unit of IL-7 was associated with decreased HIV PVL by log10 2.5. We also found that IL-7 levels correlated positively with absolute CD4+ T cell counts in HIV-infected patients. We concluded that plasma IL-5 and IL-7 may likely have a key role on viral control in HBV and HIV infections, respectively. A noteworthy increase in cytokines appears to bear protective and pathological significance, and indeed is reflective of the host's versatile immune armory against viral persistence.
  14. Guraya SS, Harkin DW, Yusoff MSB, Guraya SY
    Front Med (Lausanne), 2023;10:1230620.
    PMID: 37928467 DOI: 10.3389/fmed.2023.1230620
    In order to ensure a strong research design, literature stresses the adoption of a research paradigm that is consistent with the researcher's beliefs about the nature of reality. In this article we provide an overview of research paradigm choices in relation to the creation of a Medical Education e-Professionalism (MEeP) framework discussing the research design, research methods, data collection and analysis to enhance the transparency of our previously published research. The MEeP framework was conceived to help Health Care Professionals (HCPs) safeguard the construct of professionalism in the digital context. This entire process was heavily informed by wider readings and deliberations of published literature on e-professionalism. Although the MEeP framework research journey has been published, the paradigms approach was not discussed in any detail. Considering that one of the duties of medical educator is to balance the service and science by bringing the theoretical underpinnings of one's research to public attention and scrutiny so as to nullify the notion of 'weak' research. We were compelled to unfold this paradigm story of the MEeP framework in a detailed manner. In an effort to make our research both robust and effective, this study portrays a philosophical approach to guide future research designs and methodological choices by detailing our rationale for pragmatism as a choice of paradigm.
  15. Chaomuang N, Khamnuan P, Chuayunan N, Duangjai A, Saokaew S, Phisalprapa P
    Front Med (Lausanne), 2021;8:719830.
    PMID: 34869417 DOI: 10.3389/fmed.2021.719830
    Background: Necrotizing fasciitis (NF) is a life-threatening infection of the skin and soft tissue that spreads quickly and requires immediate surgery and medical treatment. Amputation or radical debridement of necrotic tissue is generally always required. The risks and benefits of both the surgical options are weighed before deciding whether to amputate or debride. This study set forth to create an easy-to-use risk scoring system for predicting the risk scoring system for amputation in patients with NF (ANF). Methods: This retrospective study included 1,506 patients diagnosed with surgically confirmed NF at three general hospitals in Thailand from January 2009 to December 2012. All diagnoses were made by surgeons who strictly observed the guidelines for skin and soft tissue infections produced by the Infectious Diseases Society of America. Patients were randomly allocated to either the derivation (n = 1,193) or validation (n = 313) cohort. Clinical risk factors assessed at the time of recruitment were used to create the risk score, which was then developed using logistic regression. The regression coefficients were converted into item scores, and the total score was calculated. Results: The following four clinical predictors were used to create the model: female gender, diabetes mellitus, wound appearance stage 3 (skin necrosis and gangrene), and creatinine ≥1.6 mg/dL. Using the area under the receiver operating characteristic curve (AuROC), the ANF system showed moderate power (78.68%) to predict amputation in patients with NF with excellent calibration (Hosmer-Lemeshow χ2 = 2.59; p = 0.8586). The positive likelihood ratio of amputation in low-risk (score ≤ 4) and high-risk (score ≥ 7) patients was 2.17 (95%CI: 1.66-2.82) and 6.18 (95%CI: 4.08-9.36), respectively. The ANF system showed good performance (AuROC 76.82%) when applied in the validation cohort. Conclusion: The developed ANF risk scoring system, which includes four easy to obtain predictors, provides physicians with prediction indices for amputation in patients with NF. This model will assist clinicians with surgical decision-making in this time-sensitive clinical setting.
  16. Hegazi OE, Alalalmeh SO, Alnuaimi GRH, Shahwan M, Jairoun AA, Alorfi NM, et al.
    Front Med (Lausanne), 2023;10:1227046.
    PMID: 37601777 DOI: 10.3389/fmed.2023.1227046
    BACKGROUND: Nonalcoholic Fatty Liver Disease (NAFLD) has become a significant public health concern, affecting approximately one-fourth of the population. Despite its prevalence, no FDA-approved drug treatments specifically target NAFLD.

    AIM: To provide a review of clinical trials investigating the use of herbal remedies and dietary supplements in NAFLD management, utilizing the ClinicalTrials.gov database.

    METHODS: This review evaluates the current evidence by examining completed phase III and IV clinical trials registered on ClinicalTrials.gov. An exhaustive search was performed on April 17, 2023, using the terms "Nonalcoholic Fatty Liver Disease" and "NAFLD." Two independent reviewers appraised eligible trials based on pre-defined inclusion and exclusion criteria.

    RESULTS: An initial search yielded 1,226 clinical trials, with 12 meeting the inclusion criteria after filtration. The majority of trials focused on Omega-3 fatty acids (20.0%) and vitamin D (26.7%), followed by caffeine, chlorogenic acid, ginger, phosphatidylcholine, Trigonella Foenum-graecum seed extract, vitamin C, and vitamin E (each 6.7%). Most studies were Phase 3 (75.0%) and used a parallel assignment model (91.7%). Quadruple masking was the most prevalent technique (58.3%), and Iran was the leading country in terms of trial locations (25.0%). These interventions constitute two herbal interventions and nine supplement interventions.

    CONCLUSION: This reveals a diverse range of nutraceuticals, with Omega-3 fatty acids and vitamin D being predominant in the management of NAFLD. The global distribution of trials highlights the widespread interest in these therapeutics. However, more rigorous, large-scale trials are needed to establish safety, efficacy, and optimal dosages.

  17. Za'im Sahul Hameed M, Sutan R, Mahdy ZA, Tamil AM, Sulong S
    Front Med (Lausanne), 2021;8:592462.
    PMID: 34113624 DOI: 10.3389/fmed.2021.592462
    Adverse perinatal outcomes such as stillbirth, low birth weight and small for gestational age are still reported to be of high prevalence despite advanced healthcare technology and good quality hospital services in Malaysia. The purpose of this study is to create a model to evaluate individualized birth weight customized for maternal characteristics in a Malaysian population. Three phases are involved in designing the customized fetal growth chart (GROW-My). Baseline data is collected from previous pregnancies in the UKM Medical Centre from year 2010 to 2017. Specific maternal attributes were screened for its completeness and validity, namely maternal height and weight at booking, maternal ethnicity and parity, and the baby's birth weight, for all singleton pregnancies. The design and construction of a Malaysian customized fetal growth chart, Growth Related Optimal Weight (GROW-MY) was based on baseline birth data. The customized chart is used in the implementation phase for testing its feasibility, taking into consideration feedback from caregivers and patients before and after implementation. The current study provides staunch information and data regarding the needs and strategies for using maternal variables for estimating birth weight and the risk of being small for gestational age, in order to facilitate screening and appropriate management. With improved diagnosis of fetal growth restriction, medical care and treatment costs can be reduced.
  18. Chong KM, Rajiah K, Chong D, Maharajan MK
    Front Med (Lausanne), 2022;9:884482.
    PMID: 35665362 DOI: 10.3389/fmed.2022.884482
    INTRODUCTION: In supplying medicines to patients and consumers waste can occur in prescribing, dispensing, and leftover stages. Pharmacists in community pharmacies play a crucial role in dispensing and should share information on appropriate medicines disposal with consumers. This qualitative study explored how Malaysian community pharmacists manage medication wastage, returned medicines, and medicines disposal by eliciting their opinions on medicines wastage, the challenges faced, and feasibility of medicine return and safe medicine disposal in the setting of Malaysian community pharmacy.

    METHODS: Telephonic interviews were conducted using a pre-validated interview guide among community pharmacists. Purposive sampling was used to ensure heterogeneity of participants in terms of gender, age, and position in the pharmacy. The interview was conducted until a point where no new information was obtained. Interview data were thematically analyzed.

    RESULTS: The analysis identified nine themes organized into four domains. The results revealed that pharmacists have positive perceptions of the safe disposal of medicines. Pharmacists mentioned that medicine returns to service in community pharmacies are not common due to a lack of facilities in the management of unwanted, expired, and returned medicines. As such pharmacists have suggested a few ways to minimize medicinal wastage.

    CONCLUSIONS: Respondents aimed to minimize medicines wastage (unused medicines) in order to minimize loss of revenue. Respondents did not usually accept returned medicines due to the operational costs of safe disposal. Disposal of unused medicines was undertaken by centralizing the stocks at an organization facility before being disposed of by outsourced waste management companies.

  19. Ahmad Sophien AN, Jusop AS, Tye GJ, Tan YF, Wan Kamarul Zaman WS, Nordin F
    Front Med (Lausanne), 2023;10:1195374.
    PMID: 37547615 DOI: 10.3389/fmed.2023.1195374
    The vital role of the intestines as the main site for the digestion and absorption of nutrients for the body continues subconsciously throughout one's lifetime, but underneath all the complex processes lie the intestinal stem cells and the gut microbiota that work together to maintain the intestinal epithelium. Intestinal stem cells (ISC) are multipotent stem cells from which all intestinal epithelial cells originate, and the gut microbiota refers to the abundant collection of various microorganisms that reside in the gastrointestinal tract. Both reside in the intestines and have many mechanisms and pathways in place with the ultimate goal of co-managing human gastrointestinal tract homeostasis. Based on the abundance of research that is focused on either of these two topics, this suggests that there are many methods by which both players affect one another. Therefore, this review aims to address the relationship between ISC and the gut microbiota in the context of regenerative medicine. Understanding the principles behind both aspects is therefore essential in further studies in the field of regenerative medicine by making use of the underlying designed mechanisms.
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