Displaying publications 1 - 20 of 101 in total

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  1. Adaptation of international guidelines for metastatic colorectal cancer: an asian consensus
    Cheng AL, Li J, Vaid AK, Ma BB, Teh C, Ahn JB, et al.
    Clin Colorectal Cancer, 2014 Sep;13(3):145-55.
    PMID: 25209093 DOI: 10.1016/j.clcc.2014.06.004
    Colorectal cancer (CRC) is among the most common cancers worldwide, but marked epidemiological differences exist between Asian and non-Asian populations. Hence, a consensus meeting was held in Hong Kong in December 2012 to develop Asia-specific guidelines for the management of metastatic CRC (mCRC). A multidisciplinary expert panel, consisting of 23 participants from 10 Asian and 2 European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Participants agreed that mCRC management in Asia largely follows international guidelines, but they proposed a number of recommendations based on regional 'real-world' experience. In general, participants agreed that 5-fluorouracil (5-FU) infusion regimens in doublets can be substituted with UFT (capecitabine, tegafur-uracil) and S1 (tegafur, 5-chloro-2,4-dihydroxypyridine and oxonic acid), and that the monoclonal antibodies cetuximab and panitumumab are recommended for KRAS wild type tumors. For KRAS mutant tumors, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU, and oxaliplatin) is preferred for initial therapy in Asian patients. The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus might change as more data become available.
    Matched MeSH terms: Guideline Adherence
  2. Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease
    Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R
    Ann Pharmacother, 2009 Oct;43(10):1598-605.
    PMID: 19776297 DOI: 10.1345/aph.1M187
    Appropriate drug selection and dosing for patients with chronic kidney disease (CKD) is important to avoid unwanted drug effects and ensure optimal patient outcomes.
    Matched MeSH terms: Guideline Adherence
  3. Messages from the Malaysian Diabetes Registries on Diabetes Care in Malaysian public healthcare facilities
    Chew BH, Lee PY, Cheong AT, Ismail M, Shariff-Ghazali S, Goh PP
    Prim Care Diabetes, 2016 10;10(5):383-6.
    PMID: 27459893 DOI: 10.1016/j.pcd.2016.07.003
    A persistent and increasing prevalence of diagnosed and undiagnosed diabetes mellitus has recently been reported in the National Health and Morbidity Survey 2015. This commentary recapitulates the relevant and valuable lessons in the Malaysian national diabetes registries to inform the healthcare stakeholders and policy makers on potential areas of clinical practice improvement and future researches. Under performance of the process measures and sub-optimal control of HbA1c, blood pressure and lipids profile were prevalent (<40% achieved treatment targets). Although these had improved slightly from 2009 to 2012, diabetes co-morbidities (hypertension and dyslipidaemia) and complications had also increased. Prevalence of insulin use had doubled, and lipid lowering agent use had increased about 50% in 2012 compared to 2009. We identified six clinical areas for urgent attention and improvement, and three potential areas for future research.
    Matched MeSH terms: Guideline Adherence
  4. Lipid-lowering treatment in hypercholesterolaemic patients: the CEPHEUS Pan-Asian survey
    Park JE, Chiang CE, Munawar M, Pham GK, Sukonthasarn A, Aquino AR, et al.
    Eur J Prev Cardiol, 2012 Aug;19(4):781-94.
    PMID: 21450606 DOI: 10.1177/1741826710397100
    BACKGROUND: Treatment of hypercholesterolaemia in Asia is rarely evaluated on a large scale, and data on treatment outcome are scarce. The Pan-Asian CEPHEUS study aimed to assess low-density lipoprotein cholesterol (LDL-C) goal attainment among patients on lipid-lowering therapy.
    METHODS: This survey was conducted in eight Asian countries. Hypercholesterolaemic patients aged ≥18 years who had been on lipid-lowering treatment for ≥3 months (stable medication for ≥6 weeks) were recruited, and lipid concentrations were measured. Demographic and other clinically relevant information were collected, and the cardiovascular risk of each patient was determined. Definitions and criteria set by the updated 2004 National Cholesterol Education Program guidelines were applied.
    RESULTS: In this survey, 501 physicians enrolled 8064 patients, of whom 7281 were included in the final analysis. The mean age was 61.0 years, 44.4% were female, and 85.1% were on statin monotherapy. LDL-C goal attainment was reported in 49.1% of patients overall, including 51.2% of primary and 48.7% of secondary prevention patients, and 36.6% of patients with familial hypercholesterolaemia. The LDL-C goal was attained in 75.4% of moderate risk, 55.4% of high risk, and only 34.9% of very high-risk patients. Goal attainment was directly related to age and inversely related to cardiovascular risk and baseline LDL-C.
    CONCLUSION: A large proportion of Asian hypercholesterolaemic patients on lipid-lowering drugs are not at recommended LDL-C levels and remain at risk for cardiovascular disease. Given the proven efficacy of lipid-lowering drugs in the reduction of LDL-C, there is room for further optimization of treatments to maximize benefits and improve outcomes.
    Matched MeSH terms: Guideline Adherence
  5. Fulltext Real-World Dual Antiplatelet Therapy Following Polymer-Free Sirolimus-Eluting Stent Implantations to Treat Coronary Artery Disease
    Krackhardt F, Waliszewski M, Kočka V, Toušek P, Janek B, Hudec M, et al.
    Cardiovasc Drugs Ther, 2020 06;34(3):335-344.
    PMID: 32212061 DOI: 10.1007/s10557-020-06963-5
    OBJECTIVES: The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population.

    METHODS: Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel.

    RESULTS: For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age

    Matched MeSH terms: Guideline Adherence
  6. Fulltext Failure to improve door-to-needle time by switching to emergency physician-initiated thrombolysis for ST elevation myocardial infarction
    Loch A, Lwin T, Zakaria IM, Abidin IZ, Wan Ahmad WA, Hautmann O
    Postgrad Med J, 2013 Jun;89(1052):335-9.
    PMID: 23524989 DOI: 10.1136/postgradmedj-2012-131174
    INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
    OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
    METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
    RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
    CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
    KEYWORDS: Accident & Emergency Medicine; Quality improvement
    Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur
    Matched MeSH terms: Guideline Adherence
  7. Improving safety-related knowledge, attitude and practices of nurses handling cytotoxic anticancer drug: pharmacists' experience in a general hospital, Malaysia
    Keat CH, Sooaid NS, Yun CY, Sriraman M
    Asian Pac J Cancer Prev, 2013;14(1):69-73.
    PMID: 23534806
    BACKGROUND: An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions.

    MATERIALS AND METHODS: This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical, educational and administrative support measures consisting of the initiation of closed-system cytotoxic drug reconstitution (CDR) services, courses, training workshops and guideline updates.

    RESULTS: The mean age of nurses was 32.2∓6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of nurses was significantly increased from 45.5∓10.52 to 73.4∓8.88 out of 100 (p<0.001) at the end of the second assessment. Overall, the mean practice score among the wards was improved from 7.6∓5.51 to 15.3∓2.55 out of 20 (p<0.001).

    CONCLUSIONS: The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.

    Matched MeSH terms: Guideline Adherence
  8. Fulltext Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol
    Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, et al.
    BMC Med Res Methodol, 2007;7:43.
    PMID: 17892586
    Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?
    Matched MeSH terms: Guideline Adherence
  9. A survey of contemporary opinions and practices of surgical and intensive care specialists towards peri-operative venous thromboembolism prophylaxis in Asia
    Lee L, Liew NC, Gee T
    Int Angiol, 2012 Dec;31(6):526-33.
    PMID: 23222930
    This survey was conducted to determine the opinions and practices of peri-operative venous thromboembolism (VTE) prophylaxis among surgical and intensive care specialists in Asia.
    Matched MeSH terms: Guideline Adherence
  10. Fulltext Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall schedule on time in therapeutic range
    Swarna Nantha Y
    Fam Pract, 2015 Oct;32(5):514-9.
    PMID: 26251026 DOI: 10.1093/fampra/cmv066
    BACKGROUND: The quality of anticoagulation management in atrial fibrillation patients is reflected by the concept of time spent in therapeutic range (TTR). In a primary care setting, the implementation of a dose nomogram could help increase the mean TTR among these patients.
    OBJECTIVE: This study compares the influence of a dose algorithm with an integrated recall on TTR prior to standard care and after the implementation of the protocol.
    PATIENTS AND METHODS: In a purposive sample of patients with AF, an uncontrolled 'before' and 'after' study design was utilized to measure the effects of the protocol on TTR. Demographic data, TTR levels, frequency of international normalized ratio (INR) within therapeutic range, clinician adherence to dose nomogram and warfarin dose changes were captured from consultations at the anticoagulation clinic.
    RESULTS: A total of 152 patients with AF were entered into the final analysis. The increment in mean TTR in the 'after' intervention phase (2.9%) was not statistically significant (57.5-60.4%, P=0.252). The increase in the frequency of INR values within therapeutic range in the 'after' intervention phase was significant (50.0-56.0%, P<0.05) but with a very low effect size (r=0.04).
    CONCLUSIONS: The implementation of a dose nomogram has the potential of reducing unnecessary dose changes for minor fluctuations in INR levels. The findings in this study needs to be confirmed in a future study involving other indications for anticoagulation, various regional primary care clinics and a larger population size.
    KEYWORDS: Atrial fibrillation; TTR; dose nomogram; predictors; primary care; warfarin.
    Study site: Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Guideline Adherence
  11. Fulltext Fluoroquinolones resistance in multidrug-resistant tuberculosis in Pakistan and suitability of guidelines recommended standardized regimen
    Ahmad N, Khan AH, Syed Sulaiman SA, Javaid A
    Int J Mycobacteriol, 2015 09;4(3):258-9.
    PMID: 27649876 DOI: 10.1016/j.ijmyco.2015.05.012
    Matched MeSH terms: Guideline Adherence
  12. Fulltext Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care
    Ramli AS, Lakshmanan S, Haniff J, Selvarajah S, Tong SF, Bujang MA, et al.
    BMC Fam Pract, 2014;15:151.
    PMID: 25218689 DOI: 10.1186/1471-2296-15-151
    Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol.
    Matched MeSH terms: Guideline Adherence
  13. Fulltext Antibiotic usage in surgical prophylaxis: a prospective surveillance of surgical wards at a tertiary hospital in Malaysia
    Oh AL, Goh LM, Nik Azim NA, Tee CS, Shehab Phung CW
    J Infect Dev Ctries, 2014 Feb;8(2):193-201.
    PMID: 24518629 DOI: 10.3855/jidc.3076
    INTRODUCTION: The widespread and inappropriate use of broad-spectrum antibiotics in surgical prophylaxis has led to reduced treatment efficacy, increased healthcare costs, and antibiotic resistance. This study aimed to explore the adherence of antibiotic usage in surgical prophylaxis to the national antibiotic guideline and the incidences of surgical site infection (SSI).
    METHODOLOGY: A three-month prospective observational study has been conducted in the surgical wards of Sarawak General Hospital (SGH) using a standardized surveillance form. Each patient was reviewed for up to 30 days post-operatively to determine the occurrence of SSI.
    RESULTS: A total of 87 patients were included within the study period. The majority of the cases were clean-contaminated wounds (60.9%). Most were hepatobiliary cases (37.9%), followed by colorectal cases (19.5%). The most preferred antibiotic used was cefoperazone (63.2%). The choices of antibiotics in 78.2% of the cases were consistent with the guideline. Around 80% of prophylactic antibiotics were given within one hour before operation and 27.6% were omitted from intraoperative re-dosing. Prophylactic antibiotics were discontinued within 24 hours post-operatively in 77% of the cases. Of those continued for > 24 hours, the majority (60%) were administered for unknown reasons. SSI was documented in 13.8% of the total cases studied. However, there was no significant association between choices of antibiotics and timing of surgical prophylaxis with SSI (p = 0.299 and p = 0.258 respectively).
    CONCLUSION: Overall guideline adherence rate was more than 70%. Areas of non-concordance to the guideline require further investigation.
    Matched MeSH terms: Guideline Adherence
  14. Fulltext Cardiovascular risk scores: qualitative study of how primary care practitioners understand and use them
    Liew SM, Blacklock C, Hislop J, Glasziou P, Mant D
    Br J Gen Pract, 2013 Jun;63(611):e401-7.
    PMID: 23735411 DOI: 10.3399/bjgp13X668195
    BACKGROUND: The National Institute for Health and Care Excellence guidelines and the Quality Outcomes Framework require practitioners to use cardiovascular risk scores in assessments for the primary prevention of cardiovascular disease.
    AIM: To explore GPs understanding and use of cardiovascular risk scores.
    DESIGN AND SETTING: Qualitative study with purposive maximum variation sampling of 20 GPs working in Oxfordshire, UK. Method Thematic analysis of transcriptions of face-to-face interviews with participants undertaken by two individuals (one clinical, one non-clinical).
    RESULTS: GPs use cardiovascular risk scores primarily to guide treatment decisions by estimating the risk of a vascular event if the patient remains untreated. They expressed considerable uncertainty about how and whether to take account of existing drug treatment or other types of prior risk modification. They were also unclear about the choice between the older scores, based on the Framingham study, and newer scores, such as QRISK. There was substantial variation in opinion about whether scores could legitimately be used to illustrate to patients the change in risk as a result of treatment. The overall impression was of considerable confusion.
    CONCLUSION: The drive to estimate risk more precisely by qualifying guidance and promoting new scores based on partially-treated populations appears to have created unnecessary confusion for little obvious benefit. National guidance needs to be simplified, and, to be fit for purpose, better reflect the ways in which cardiovascular risk scores are currently used in general practice. Patients may be better served by simple advice to use a Framingham score and exercise more clinical judgement, explaining to patients the necessary imprecision of any individual estimate of risk.
    Matched MeSH terms: Guideline Adherence
  15. Fulltext Indications and outcome of anti-phospholipid syndrome testing in an obstetric population at Sabah Women & Children Hospital, Kota Kinabalu, Sabah, Borneo Malaysia
    Valayatham V
    Med J Malaysia, 2012 Aug;67(4):399-401.
    PMID: 23082449 MyJurnal
    AIM: We audited indications and outcomes of antiphospholipid syndrome (APS) screening in the pregnant population at our centre.
    METHOD: Prospective and observational. All APS test results returned were audited for validity of indication and subsequent outcome.
    RESULT: 24 of a total of 146 (16%) of requests for the antiphospholipid antibodies and lupus anticoagulant were not indicated. Two positive results returned for a total of 116 "indicated" requests (1.7%).
    CONCLUSION: There needs to be increased awareness among obstetricians on the indications for screening for antiphospholipid syndrome (APS). The prevalence of antiphospholipid syndrome with obstetric manefestations in the study population is lower than rates published in the literature.
    Matched MeSH terms: Guideline Adherence
  16. Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia
    Hamid MZ, Aziz NA, Anita AR, Norlijah O
    Southeast Asian J. Trop. Med. Public Health, 2010 Sep;41(5):1192-9.
    PMID: 21073041
    This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. We also aimed to assess the practices of universal precautions amongst these workers and its correlation with the facts. We carried out a cross-sectional study from January to July 2008 involving various levels of health-care workers in Serdang Hospital, Selangor, Malaysia. A self-administered questionnaire assessing knowledge of blood-borne diseases and universal precautions, and actual practice of universal precautions was used. Two hundred fifteen respondents participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice of universal precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions.
    Matched MeSH terms: Guideline Adherence
  17. Compliance towards dispensed medication labelling standards: a cross-sectional study in the state of Penang, Malaysia
    Neoh CF, Hassali MA, Shafie AA, Awaisu A, Tambyappa J
    Curr Drug Saf, 2009 Sep;4(3):199-203.
    PMID: 19534650
    Good medicine labelling practice is vital to ensure safe use of medicines. Non-compliance to labelling standards is a potential source of medication errors. This study was intended to evaluate and compare compliance towards labelling standard for dispensed medications between community pharmacists and general practitioners in Penang, Malaysia. A total of 128 community pharmacies and 26 general practitioners' clinics were visited. Using 'Simulated Client Method' (SCM), data were collected on the medications dispensed upon presentation of hypothetical common cold symptoms. The medications dispensed were evaluated for labelling adequacy. Result revealed that majority of the dispensed medications obtained were not labelled according to regulatory requirements. However, general practitioners complied better than community pharmacists in terms of labelling for: name of patient (p<0.001), details of supplier (p<0.001), dosage of medication (p=0.023), frequency to take medication (p=0.023), patient's reference number (p<0.001), date of supply (p<0.001), special instructions for medication (p=0.008), storage requirements (p=0.002), and indication for medication (p<0.001). Conversely, community pharmacists labelled dispensed medications with the words "Controlled Medicine" more often than did general practitioners (p<0.001). Although laws for labelling dispensed medicines are in place, most community pharmacists and general practitioners did not comply accordingly, thereby putting patients' safety at risks of medication errors.
    Matched MeSH terms: Guideline Adherence
  18. Fulltext Non-achievement of clinical targets in patients with type 2 diabetes mellitus
    Eid M, Mafauzy M, Faridah AR
    Med J Malaysia, 2004 Jun;59(2):177-84.
    PMID: 15559167 MyJurnal
    The study was conducted to determine whether the clinical targets for the control of diabetes recommended by American Diabetes Association can be met in the context of routine diabetes practice. This cross-sectional study was undertaken on 211 type 2 diabetic patients at the Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM) Kubang Kerian, Kelantan between the year 2001-2002. Patients' physical examination and their medical history as well as their family history were obtained by administering a structured questionnaire. Samples of patients' venous blood during fasting were taken and analysed for plasma glucose, glycated haemoglobin and lipid profile. Analysis showed that many patients had comorbidities or complications. A large number of them had poor glycaemic control (73%). Systolic and diastolic blood pressures of 75% and 85% subjects were > or = 130 and > or = 80 mmHg, respectively. Body Mass Index (BMI) values of 66% of the patients were outside the clinical target (BMI > or = 25 in male and > or = 24 kg/m2 in female). The lipid profile showed that 96% of the patients had at least one lipid value outside the clinical target level. In this study, 70% of the patients had total cholesterol > or = 5.2 mmol/L, 87% had LDL cholesterol > or = 2.6 mmol/L, 57% had HDL cholesterol less than the normal range, < or = 1.15 mmol/L in men and < or = 1.4 mmol/L in women, while 46% had triglycerides > or = 1.71 mmol/L. Complications of diabetes were observed in 48% of the total number of patients. As for the patients' systolic blood pressure, age and duration of diabetes were found to have significant effects. Older subjects with a longer duration of diabetes were more hypertensive. Variables that had significant effects on BMI were age, duration of diabetes, glycaemic control and gender. Younger females and newly diagnosed subjects with better glycaemic control (A1C < 7%) were found to have higher BMI values. The overall clinical targets were suboptimal. The prevalence of hyperlipidaemia and hypertension was high. It is imperative that better treatment strategies and methods be adopted to enhance diabetes control and reduce long-term complications of the disease.

    Study site: Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM)
    Matched MeSH terms: Guideline Adherence
  19. Fulltext Prescribing patterns for childhood asthma treatment in general practice
    Chan PWK, Norzila MZ
    Med J Malaysia, 2003 Oct;58(4):475-81.
    PMID: 15190621
    The treatment preferences of 109 general practitioners (GPs) for childhood asthma were determined. Availability and adherence to clinical practice guidelines (CPG) for the treatment of childhood asthma was also assessed. Ninety eight (90%), 60 (55%) and 33 (30%) GPs considered nocturnal symptoms > 2 times/week, exercise induced wheeze and cough respectively as indications for preventer therapy. An oral preparation was preferred for relief medication [72 (66%) for 2-5 years, 60 (55%) for > 5 years]. An inhaled preparation was however preferred for preventer medication [60 (55%) for 2-5 years, 85 (78%) for > 5 years]. The oral form was more likely prescribed for asthmatic children 2-5 years (p < 0.001). Corticosteroids and ketotifen were the commonest inhaled and oral preventer treatment prescribed respectively. Only 36(33%) GPs have a CPG copy for reference. Children with asthma symptoms that require preventer therapy may not always be identified in general practice. The oral route remains important for asthma medication especially in young children. The accessibility to the CPG among GPs is disappointing.
    Study site: General practitioners attending a pharmaceutical industry sponsored asthma management workshop
    Matched MeSH terms: Guideline Adherence
  20. Fulltext Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria
    Abubakar U, Syed Sulaiman SA, Adesiyun AG
    PLoS One, 2019;14(3):e0213395.
    PMID: 30845240 DOI: 10.1371/journal.pone.0213395
    BACKGROUND: Inappropriate and excessive use of surgical antibiotic prophylaxis are associated with the emergence of antibiotic resistance. Antibiotic prophylaxis malpractices are common in obstetrics and gynecology settings and antibiotic stewardship is used to correct such malpractice.

    OBJECTIVE: To evaluate the impact of antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis practice in obstetrics and gynecology surgeries.

    METHOD: A prospective pre- and post-intervention study was conducted in two tertiary hospitals between May and December 2016. The duration of the each period was 3 months. Antibiotic stewardship interventions including development of a protocol, educational meeting and audit and feedback were implemented. Data were collected using the patient records and analyzed with SPSS version 23.

    RESULTS: A total of 226 and 238 surgical procedures were included in the pre- and post-intervention periods respectively. Age, length of stay and estimated blood loss were similar between the two groups. However, specialty and surgical procedures varied significantly. There was a significant increase in compliance with timing (from 14.2% to 43.3%) and duration (from 0% to 21.8%) of surgical antibiotic prophylaxis after the interventions. The interventions significantly reduced the prescription of third generation cephalosporin (-8.6%), redundant antibiotic (-19.1%), antibiotic utilization (-3.8 DDD/procedure) and cost of antibiotic prophylaxis (-$4.2/procedure). There was no significant difference in the rate of surgical site infection between the two periods. Post-intervention group (OR: 5.60; 95% CI: 3.31-9.47), elective surgery (OR: 4.62; 95% CI: 2.51-8.47) and hospital attended (OR: 9.89; 95% CI: 5.66-17.26) were significant predictors of compliance with timing while elective surgery (OR: 12.49; 95% CI: 2.85-54.71) and compliance with timing (OR: 58.55; 95% CI: 12.66-270.75) were significantly associated with compliance to duration of surgical antibiotic prophylaxis.

    CONCLUSION: The interventions improve compliance with surgical antibiotic prophylaxis and reduce antibiotic utilization and cost. However, there is opportunity for further improvement, particularly in non-elective surgical procedures.

    Matched MeSH terms: Guideline Adherence
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