Displaying publications 221 - 240 of 322 in total

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  1. Anees Ur Rehman, Ahmad Hassali MA, Muhammad SA, Shah S, Abbas S, Hyder Ali IAB, et al.
    Expert Rev Pharmacoecon Outcomes Res, 2020 Dec;20(6):661-672.
    PMID: 31596632 DOI: 10.1080/14737167.2020.1678385
    Background: Lack of information about economic burden of COPD is a major cause of lack of attention to this chronic condition from governments and policymakers. Objective: To find the economic burden of COPD in Asia, USA and Europe, and to identify the key cost driving factors in management of COPD patients. Methodology: Relevant studies assessing the cost of COPD from patient perspective or societal perspective were retrieved by thoroughly searching PUBMED, SCIENCE DIRECT, GOOGLE SCHOLAR, SCOPUS, and SAGE Premier Databases. Results: In the USA annual per patient direct medical cost and hospitalization cost were reported as $10,367 and $6852, respectively. In Asia annual per patient direct medical cost in Iran, Korea and Singapore was reported as $1544, $3077, and $2335, respectively. However, annual per patient hospitalization cost in Iran, Korea, Singapore, India, China, and Turkey was reported as $865, $1371, $1868, $296, $1477 and $1031, respectively. In Europe annual per patient direct medical cost was reported as $11,787, $10,552, $8644, $8203, $7760, $3190, $1889, $2162, and $2254 in Norway, Denmark, Germany, Italy, Sweden, Greece, Spain, Belgium, and Serbia, respectively. Conclusion: Limiting the disease to early stage and preventing exacerbations may reduce the cost of management of COPD.
  2. Sulaiman SAS, Khan AH, Ahmad N, Iqubal MS, Muttalif AR, Hassali MA
    Am J Med Sci, 2013 Apr;345(4):321-325.
    PMID: 23531965 DOI: 10.1097/MAJ.0b013e318288f8f3
    BACKGROUND: Concurrent diabetes mellitus (DM) with tuberculosis (TB) has an increased risk of treatment failure. This study was aimed to evaluate treatment outcomes in patients with TB with and without DM.

    METHODS: A retrospective cohort study was conducted at respiratory clinic of Hospital Pulau Pinang, Malaysia. All TB-registered patients from January 2006 to December 2007 were included in the study. A validated data collection form was used for collecting data. World Health Organization's criterion was used for categorizing treatment outcomes. Data were analyzed by using SPSS 16.

    RESULTS: Of 1267 patients, 338 patients (26.7%) had concurrent TB-DM. In multivariate analysis, TB-DM was more likely to be present in Chinese (odds ratio [OR] = 1.401, P = 0.011), patients having age of 46 to 60 years (OR = 3.168, P < 0.001) and >60 years (OR = 2.524, P < 0.001) and patients with pulmonary TB (OR = 2.079, P < 0.001). Nine hundred and eighty-five (78.8%) patients were successfully treated. No statistically significant difference was observed between 2 groups: patients with TB-DM and patients with only TB. Successful treatment outcomes were observed in patients having age of 46 to 60 (OR = 1.567, P = 0.001), whereas male gender (OR = 0.721, P = 0.049) and patients with relapse TB (OR = 0.494, P = 0.002) were less likely to have successful treatment outcome.

    CONCLUSIONS: High prevalence of TB-DM in the study signifies the fact that patients with DM are at high risk of developing TB. Treatment outcomes in both groups were comparable. The gender-based and age-based disparity in TB treatment outcomes in this study indicates the importance of gender-specific and age-specific strategies of TB management.

    Study site: respiratory clinic of Hospital Pulau Pinang
  3. Al-Qazaz HK, Syed Sulaiman SA, Hassali MA, Shafie AA, Sundram S
    Practical Diabetes International, 2010;27(6):238-241a.
    DOI: 10.1002/pdi.1495
    The aims of this study were to translate the Michigan Diabetes Knowledge Test (MDKT) into the Malaysian language, and to examine the psychometric properties of the Malaysian version. A standard translation procedure was used to create the Malaysian version of the MDKT from the original English version. A convenience sample of 307 outpatients with type 2 diabetes was identified between May and October 2009. All data were collected from the Penang General Hospital, Penang, Malaysia. Instruments consisted of the Malaysian version of the MDKT and a socio-demographic questionnaire. Medical records were reviewed for haemoglobin A1c (HbA1c) levels and other clinical data. Reliability was tested for internal consistency using Cronbach’s alpha coefficient. Employing the recommended scoring method, the mean±SD of MDKT scores was 7.88±3.01. Good internal consistency was found (Cronbach’s alpha = 0.702); the test-retest reliability value was 0.894 (p<0.001). For known group validity, a significant relationship between MDKT categories and HbA1c categories (chi-square = 21.626; p≥0.001) was found. The findings of this validation study indicate that the Malaysian version of the MDKT is a reliable and valid measure of diabetes knowledge which can now be used in clinical and research practice.
    KEY WORDS: diabetes knowledge; validation; Michigan test; translation
    Study site: Diabetes Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia.
  4. Hashmi F, Hassali MA, Saleem F, Saeed H, Islam M, Malik UR, et al.
    Int J Clin Pharm, 2021 Aug;43(4):1090-1100.
    PMID: 33411180 DOI: 10.1007/s11096-020-01221-y
    Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' perspectives and preparedness about practice change and associated facilitators and barriers to extended services. Setting A study was conducted involving community pharmacists of Lahore, Pakistan. Method Two phased studies were conducted using mixed-method sequential design. The first phase involved qualitative semi-structured face-to-face interviews with the community pharmacists, while the second phase constituted a questionnaire-based cross-sectional study. Main outcome measure Pharmacists' perspectives about extended pharmacy services, facilitators, barriers and preparedness for the practice change. Results For the first phase, pharmacists were purposively sampled and the saturation yielded a final sample size of fifteen pharmacists (N = 15). The thematic content analysis yielded four distinct themes; (1) current practices and familiarity with extended pharmacy services (2) practice gap between Pakistan and the developed countries (3) facilitators and the preparedness, and (4) barriers towards its implementation and provision. The second part was a questionnaire-based cross-sectional phase, where a total of 348 community pharmacists were approached, while only 242 responded, yielding a response rate of 69.5%. The triangulation of qualitative and quantitative data identified several barriers such as; shortage of pharmacists, lack of knowledge and skills, poor collaboration with general practitioners, failure of customers to pay for extended services. Facilitators and preparedness for the provision of extended pharmacy services were; access to patient notes, follow-up, separate counselling areas, accreditation of specific services and sufficient resources. Conclusion This study's findings call for the implementation and enforcement of Punjab Drug Sale Rules 2007 to facilitate the practice change and provision of comprehensive pharmacy services in Punjab, Pakistan. There is a need for additional laws to define community pharmacists' roles, uniform job description, training, new funding model, separate area, and accreditation of extended pharmacy services in Pakistan.
  5. Al-Abdulkarim DA, Aljadhey HS, Mahmoud MA, Poff GA, Hassali MA, Ali S
    Hosp Pharm, 2021 Aug;56(4):368-373.
    PMID: 34381276 DOI: 10.1177/0018578720910385
    Background: Spontaneous reporting systems are essential as they help detect serious unknown adverse drug reaction (ADR). However, underreporting of ADR is a commonly associated problem. This research work aims to assess knowledge, barriers, and factors that encourage the reporting of ADR among physicians.

    Methods: A total of 600 physicians working at a tertiary referral hospital in Riyadh, Saudi Arabia, were included in this cross-sectional study. A pretested questionnaire was used.

    Results: Out of the 600 physicians, 240 (40%) completed the questionnaire. Most of the participants (85.4%) could correctly define ADR; nearly 75% physicians were unaware of the spontaneous reporting of ADR in Saudi Arabia. A total of 175 (72.9%) physicians had not reported any ADR among their patients in the last year; 40% of the physicians said that they did not report ADR because they were unaware of the online reporting of ADR. Providing guidelines and regular bulletins on the reporting of ADR is a critical aspect that encourages physicians to report ADR (51%). Education and training are the most recognized measures for improving the reporting of ADR.

    Conclusion: Physicians were adequately aware of ADR but inadequately aware of the reporting system and reporting authorities. Continuing medical education, training, and integration of the reporting of ADR into physicians' various clinical activities may improve ADR reporting.

  6. Chew CC, Chan HK, Chang CT, Hss AS, Hassali MA
    BMC Pediatr, 2021 05 03;21(1):216.
    PMID: 33941117 DOI: 10.1186/s12887-021-02691-3
    BACKGROUND: Caregivers' knowledge, practice and adherence in medication administration who care for children with chronic illness requiring long-term pharmacological treatments are factors associating with children medication safety at home. This study aimed to determine the medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. This cross-sectional study was conducted at the paediatric outpatient clinic of a tertiary public hospital. Caregivers of chronically ill children, who engaged in medication administration at home for at least 3 months, were conveniently recruited. Their medication-related knowledge and administration practice were evaluated based on a checklist, while their adherence to medication administration was assessed using a validated 5-point scale. The associated factors were also explored.

    RESULTS: Of the 141 participants, most were mothers (90.8%) and had a full-time job (55.3%). Most of them had adequate medication-related knowledge (71.6%) and an appropriate administration practice (83.0%). The majority of them (83.0%) also rated themselves as adherent to medication administration. The participants with a child above 5 years of age (91.2%) were found to have a better practice than those with younger children (75.3%) in medication administration (p = 0.012). However, those with a child taking two (adjusted OR: 12.53) or three (adjusted OR: 8.29) medications, getting their refills from private health institutions apart from this hospital (adjusted OR = 7.06) and having multiple illnesses (adjusted OR = 21.25) were more likely to be not adherent to medication administration.

    CONCLUSION: Caregivers of chronically ill children in Malaysia generally have sufficient knowledge and an appropriate practice of medication administration at home. Yet, strategies to improve the adherence to medication administration, particularly in those who care for children with complicated health conditions, are warranted.

  7. Akhtar A, Khan AH, Zainal H, Ahmad Hassali MA, Ali I, Ming LC
    Front Public Health, 2020;8:601961.
    PMID: 33324603 DOI: 10.3389/fpubh.2020.601961
    Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system. Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis. Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance. Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.
  8. Ong SC, Vasan Thakumar A, Ooi GS, Shafie AA, Ahmad Hassali MA
    Int J Pharm Pract, 2020 Dec;28(6):579-590.
    PMID: 33074560 DOI: 10.1111/ijpp.12673
    OBJECTIVE: Unregistered medications which are lacking regulation in terms of safety, efficacy and quality may cause unpredictable adverse drug reactions (ADRs) in consumers. Therefore, this study aimed to assess the public knowledge, attitude and practice of consuming and purchasing unregistered health products in Malaysia.

    METHODS: A cross-sectional study involving members of the Malaysian public was carried out using the convenience sampling method. Descriptive statistics were used to summarise the socio-demographic characteristics of the respondents. Associations between knowledge items/scores and other items were assessed using Spearman's rank correlations and Cramer's V. Regression analyses were carried out to determine whether the socio-demographic characteristics of the respondents influenced knowledge and practice relating to unregistered medications.

    KEY FINDINGS: A total of 649 respondents completed the questionnaire with the majority being female (66.1%), unmarried (66.5%), Malay (52.5%) and possessing a bachelor's degree (53.5%). The knowledge of the public surveyed regarding unregistered (unlicensed) medications was lacking, especially in being able to identify a registered health product in Malaysia and formally complaining if necessary. The respondents agreed that currently, there are insufficient laws and educational programmes to tackle the issue. The respondents exhibited good practice habits by purchasing their medications from healthcare professionals. Mean knowledge score was positively correlated to practice scores at rs  = 0.423 (P-value 

  9. Saleh MS, Hong YH, Muda MR, Dali AF, Hassali MA, Khan TM, et al.
    Eur J Hosp Pharm, 2020 05;27(3):173-177.
    PMID: 32419939 DOI: 10.1136/ejhpharm-2018-001679
    Objective: The increase in antimicrobial resistance and the lack of new antimicrobial agents in drug discovery pipelines have called for global attention to mitigate the problem of antimicrobial misuse. While an antimicrobial stewardship (AMS) programme has been implemented in Malaysia, the perception and practices of public hospital pharmacists remain unknown. The aim of this study was to determine the perception and practices of Malaysian public hospital pharmacists towards the AMS programme in the state of Selangor, Malaysia.

    Methods: A cross-sectional study, using a validated 23-item self-administered questionnaire, was conducted among pharmacists from 11 public hospitals in the State of Selangor, Malaysia, from December 2016 to January 2017. All public hospital pharmacists (n=432) were invited to participate in the survey. A 5-point Likert scale was employed in the questionnaire; the perception section was scored from 1 (strongly disagree) to 5 (strongly agree) while the practice section was scored from 1 (never) to 5 (always). Both descriptive and inferential statistical analyses were used to analyse data.

    Results: Of the 432 pharmacists surveyed, 199 responded, giving a response rate of 46.0%. The majority of the respondents agreed (n=190, 95.5%) that the AMS programme improves patient care at their hospitals (median=5; IQR=1). Slightly less than half of the respondents indicated that a local antibiotic guideline was established in their hospitals (median=3, IQR=2.5), and had taken part in antimicrobial awareness campaigns to promote optimal use of antimicrobials in hospitals (median=3, IQR=1).

    Conclusions: Overall, the perception and practices of the surveyed hospital pharmacists towards AMS programme were positive. National antibiotic guidelines, which take into consideration local antimicrobial resistance patterns, should be used fully to improve antimicrobial usage and to reduce practice variation. Collaboration among healthcare professionals should be strengthened to minimise the unfavourable consequences of unintended use of antimicrobial agents while optimising clinical outcomes.

  10. Chan HK, Hassali MA, Lim CJ, Saleem F, Ghani NA
    Pharm Pract (Granada), 2016 Apr-Jun;14(2):699.
    PMID: 27382422 DOI: 10.18549/PharmPract.2016.02.699
    BACKGROUND: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used.
    OBJECTIVE: To identify potential areas to improve the existing labels used for pediatric liquid medications.
    METHODS: This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach.
    RESULTS: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions.
    CONCLUSION: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.
    KEYWORDS: Child; Drug labeling; Hospital; Hospital Information Systems; Malaysia; Medication Errors; Pharmacy Service
  11. Shankar PR, Hassali MA, Shahwani NA, Iqbal Q, Anwar M, Saleem F
    Lancet Glob Health, 2016 10;4(10):e689.
    PMID: 27633429 DOI: 10.1016/S2214-109X(16)30214-5
  12. Shafie AA, Chaiyakunapruk N, Supian A, Lim J, Zafra M, Hassali MA
    Orphanet J Rare Dis, 2016 08 02;11(1):107.
    PMID: 27484654 DOI: 10.1186/s13023-016-0460-9
    BACKGROUND: Rare diseases, also referred to as orphan diseases, are characterised by their low prevalence with majority of them are chronically debilitating and life threatening. Given the low prevalence and the widely dispersed but very small patient base for each disease, there may often be a disproportion in the availability of treatments and resources to manage patients, spur research and train experts. This is especially true in Southeast Asian countries that are currently in the process of implementing or revising their universal health coverage schemes. This paper aims to examine the status of rare disease management in Southeast Asian countries. It will serve as the basis for a more active discussion on how countries in the region can address an under-recognised rare disease burden and enhance national and regional capacities.

    METHODS: The study consists of literature reviews and key stakeholders interviews in six focus countries, including the Philippines, Singapore, Malaysia, Indonesia, Vietnam, and Thailand and five countries as best practice, comprising of France, Canada, Australia, Taiwan, and South Korea. Rare disease management initiatives across each country were examined based on the World Health Organization's framework for action in strengthening health systems.

    RESULTS: The results suggest rare disease management remains challenging across Southeast Asia, as many of the focus countries face fundamental issues from basic healthcare systems to funding. Nonetheless, there are substantial improvement opportunities, including leveraging best practices from around the world and organising a multi-stakeholder and regional approach and strategy.

    CONCLUSIONS: Southeast Asian countries have made significant progress in the management of rare disease, but there remain key areas for substantial development opportunities.

  13. Farooqui M, Hassali MA, Shatar AK, Farooqui MA, Saleem F, Haq NU, et al.
    J Tradit Complement Med, 2016 Oct;6(4):321-326.
    PMID: 27774413
    The use of Complementary and Alternative Medicine (CAM; bǔ chōng yǔ tì dài yī xué) has been rapidly increasing among cancer patients. However, this pervasiveness is still largely unexplored among Malaysian cancer patients. The current study aimed to evaluate the patterns of CAM use among cancer patients from a local hospital in Malaysia. In addition, the study focused on the information-seeking behavior and CAM use disclosure to doctors. Of 393 patients, 184 (46.1%) had used CAM for their cancers. CAM usage was significantly associated with gender (p = 0.021), level of education (p = 0.001), employment status (p = 0.02), and monthly income (p 
  14. Abdulelah J, Sulaiman SAS, Hassali MA, Blebil AQ, Awaisu A, Bredle JM
    Value Health Reg Issues, 2015 May;6:53-59.
    PMID: 29698193 DOI: 10.1016/j.vhri.2015.03.006
    BACKGROUND: Various generic instruments exist to assess health-related quality of life (HRQOL) in patients with tuberculosis (TB), but a psychometrically sound disease-specific instrument is lacking.

    OBJECTIVES: The present study aimed to develop and psychometrically validate a multidimensional TB-specific HRQOL instrument relevant to the value of patients with pulmonary TB in Iraq with an eye toward cross-cultural application.

    METHODS: The core general HRQOL questionnaire is composed of the Functional Assessment of Cancer Therapy-General items. A modular approach was followed for the development of the Functional Assessment of Chronic Illness Therapy-Tuberculosis (FACIT-TB) questionnaire in which a set of items assessing quality-of-life (QOL) issues not sufficiently covered by the core Functional Assessment of Cancer Therapy-General items, but considered to be relevant to the target population, was added. Moreover, principal-component analysis was used to determine the new subscale structure of the questionnaire.

    RESULTS: In addition to the 27 items of the core questionnaire, a set of 20 items referring to disease symptoms related to the site of infection, adverse effects, and additional QOL dimensions such as fatigue, social stigma, and economic burden of the illness was included. Factor analysis demonstrated that the FACIT-TB construct comprised five domains.

    CONCLUSIONS: A rigorous method was applied in the development of the FACIT-TB measure to fully understand the impact of TB on patients' QOL. The instrument is psychometrically sound and portrays multiple important dimensions of HRQOL. FACIT-TB is relatively brief, is easy to administer and score, and is appropriate for use in clinical trials and practice.
  15. Hassali MA, Arief M, Saleem F, Khan MU, Ahmad A, Mariam W, et al.
    Pharm Pract (Granada), 2017 Apr-Jun;15(2):929.
    PMID: 28690695 DOI: 10.18549/PharmPract.2017.02.929
    OBJECTIVE: The present study was aimed to evaluate the practices and attitudes of young Malaysian adults towards the use of antibiotics, and to determine the socioeconomic factors associated with the antibiotic use.

    METHODS: A survey was carried in Cheras community by approaching a conveniently selected sample of 480 participants. A pre-tested questionnaire was used for data collection.

    RESULT: Of 480 participants approached, 400 agreed to participate in this study, giving a response rate of 83.3%. The study results showed that 42.75% of the participants exhibited poor attitudes towards antibiotic usage. Chinese race and high income were significantly associated with the positive attitudes towards antibiotic usage. It is shown that the practice of the participants towards antibiotics was relatively poor. The majority of participants agreed that they do not consult a doctor for minor illnesses (64%). The main reason for not consulting a doctor was the high fees of consultation (34.25%) and the inconvenience of visit (29.25%). However, a large proportion of respondents (77.5%) agreed that there is a need to enhance antibiotic education among public.

    CONCLUSION: The study results identified some crucial gaps in the attitudes and practices of Cheras community about the use of antibiotics. Thus, improving the public knowledge and changing their attitude towards antibiotic use along with proper interventions to regulate the ease of their availability would play a significant role for the effective use of antibiotics in the community.
  16. Hashmi FK, Hassali MA, Khalid A, Saleem F, Aljadhey H, Babar ZUD, et al.
    BMC Health Serv Res, 2017 07 19;17(1):500.
    PMID: 28724411 DOI: 10.1186/s12913-017-2442-6
    BACKGROUND: In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan.

    METHODS: A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework.

    RESULTS: Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings.

    CONCLUSION: Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan.

  17. Hamzah AB, Choo YM, Hassali MA, Saleem F, Verma AK
    J Clin Diagn Res, 2017 Jan;11(1):XD01-XD02.
    PMID: 28274032 DOI: 10.7860/JCDR/2017/22582.9313
    Disseminated Intravascular Coagulation (DIC) develops in patient with prostate cancer, which is manifested by systemic, intracranial, intracavitary or intracutaneous bleeding indicating uncompensated or excessive fibrinolysis (XFL). This case report is a description of a 61-year-old male with metastatic prostate cancer that progressed to manifest DIC. The condition is rare in clinical practice, and even rarer when is coupled with XFL. Treatment was mainly replenishing coagulation factors, platelets and controlling the disease progression with aggressive hormonal therapy. The patient progressed to coagulopathy further with fibrinolysis, hence leading to mortality. This case study discusses the pathophysiology of this complication and various methods to monitor the disease progression are discussed.
  18. Anchah L, Hassali MA, Lim MS, Ibrahim MI, Sim KH, Ong TK
    Health Qual Life Outcomes, 2017 Jan 13;15(1):10.
    PMID: 28086784 DOI: 10.1186/s12955-016-0583-7
    BACKGROUND: Acute Coronary Syndrome (ACS) is one of the most burdensome cardiovascular diseases in terms of the cost of interventions. The Cardiac Rehabilitation Programme (CRP) is well-established in improving clinical outcomes but the assessment of actual clinical improvement is challenging, especially when considering pharmaceutical care (PC) values in phase I CRP during admission and upon discharge from hospital and phase II outpatient interventions. This study explores the impact of pharmacists' interventions in the early stages of CRP on humanistic outcomes and follow-up at a referral hospital in Malaysia.

    METHODS: We recruited 112 patients who were newly diagnosed with ACS and treated at the referral hospital, Sarawak General Hospital, Malaysia. In the intervention group (modified CRP), all medication was reviewed by the clinical pharmacists, focusing on drug indication; understanding of secondary prevention therapy and adherence to treatment strategy. We compared the "pre-post" quality of life (QoL) of three groups (intervention, conventional and control) at baseline, 6 months and 12 months post-discharge with Malaysian norms. QoL data was obtained using a validated version of Short-Form 36 Questionnaire (SF-36). Analysis of variance (ANOVA) with repeated measure tests was used to compare the mean differences of scores over time.

    RESULTS: A pre-post quasi-experimental non-equivalent group comparison design was applied to 112 patients who were followed up for one year. At baseline, the physical and mental health summaries reported poor outcomes in all three groups. However, these improved gradually but significantly over time. After the 6-month follow-up, the physical component summary reported in the modified CRP (MCRP) participants was higher, with a mean difference of 8.02 (p = 0.015) but worse in the mental component summary, with a mean difference of -4.13. At the 12-month follow-up, the MCRP participants performed better in their physical component (PCS) than those in the CCRP and control groups, with a mean difference of 11.46 (p = 0.008), 10.96 (p = 0.002) and 6.41 (p = 0.006) respectively. Comparing the changes over time for minimal important differences (MICD), the MCRP group showed better social functioning than the CCRP and control groups with mean differences of 20.53 (p = 0.03), 14.47 and 8.8, respectively. In role emotional subscales all three groups showed significant improvement in MCID with mean differences of 30.96 (p = 0.048), 31.58 (p = 0.022) and 37.04 (p 

  19. Khan MU, Arief M, Ahmad A, Malik S, Gogoi LJ, Kalita M, et al.
    Int J Clin Pharm, 2017 Apr;39(2):473-477.
    PMID: 28260131 DOI: 10.1007/s11096-017-0443-5
    Background Shortage of qualified medical doctors and little or no access to basic medicines and medical facilities are the major rural health concerns in India. Expanding the role of pharmacists to provide prescribing services could improve rural health outcomes. Objective To assess the attitudes of rural population towards pharmacist prescribing and their interest in using expanded pharmacist prescribing services. Setting Rural population of Assam, India. Methods A descriptive, cross-sectional survey was conducted for a period of 2 months from March to April 2016 in the State of Assam, India. A multi-stage sampling was used to recruit (n = 410) eligible participants. Main outcome measure Rural population attitudes towards, and interests in using, pharmacist prescribing services. Results The attitudes of participants were generally positive towards pharmacist prescribing. A large proportion of participants (81.5%) agreed that pharmacists should have a prescribing role in rural India. Participants indicated their interest in using expanded pharmacist prescribing services, with greater interests in receiving medications in emergency situations (79.7%) and getting a treatment plan for their medical problem (75.6%). Participants with low income and tertiary education had better attitudes and showed more interest towards expanded pharmacist prescribing services (p 
  20. Ismail WI, Ahmad Hassali MA, Farooqui M, Saleem F, Roslan MNF
    Complement Ther Clin Pract, 2018 Nov;33:71-76.
    PMID: 30396630 DOI: 10.1016/j.ctcp.2018.06.004
    BACKGROUND AND PURPOSE: This study investigated the disclosure of complementary and alternative medicine (CAM) use to health care providers by Malaysian thalassemia patients.

    METHODS: The semi-structured interviews were audio taped, transcribed verbatim, and translated into English.

    RESULTS: Thematic analysis identified four themes: 1) reason for CAM disclosure, 2) attempt to disclose CAM, 3) withdrawal from CAM disclosure, and 4) non-disclosure of CAM use. The reason for patients' disclosure of CAM use to healthcare providers is because they wanted to find information about CAM and were afraid of the interaction between the conventional medicine and CAM. Patients also disclosed the use of CAM because they were not satisfied with the conventional medicine that had caused them harm.

    CONCLUSION: Effective communication between patients and health care providers is important, especially for patients who are undergoing conventional thalassemia treatment, for fear that there is an interaction between conventional treatment and CAM use.

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