MyMedR

Displaying publications 301 - 320 of 347 in total

Abstract:

Sort:

Fulltext Transition of Care in Paediatric Surgery: Current practices and perspectives of paediatric surgeons in Malaysia

Tan SK, Sanmugam A, Danaee M, Ramanujam TM, Nallusamy MA, Zahari Z, et al.

Sultan Qaboos Univ Med J, 2019 Nov;19(4):e352-e358.
PMID: 31897319 DOI: 10.18295/squmj.2019.19.04.011

Objectives: Transition of care (TOC) from paediatric to adult care is still at an early stage in Malaysia. This study aimed to explore current practices and perspectives regarding TOC among paediatric surgeons in Malaysia.
Methods: This study was carried out between June and December 2017. All 48 paediatric surgeons currently working in Malaysia were invited to participate in a questionnaire-based survey to assess demographic characteristics and practices and perspectives regarding TOC.
Results: A total of 38 paediatric surgeons participated in the survey (response rate: 79.2%). Overall, 97.4% did not have an organised TOC model in their institution, with most (65.8%) caring for paediatric patients with complex surgical conditions until adulthood. Although the majority (86.8%) felt that care should be transitioned to adult surgeons with appropriate credentials, most surgeons (84.2%) nevertheless preferred to be involved in the management of adolescent patients after transition. However, there was no consensus regarding the most suitable age to begin the transition. Years of experience as a paediatric surgeon and place of practice did not affect overall TOC practice scores (P >0.050 each). The presence of adult comorbidities was considered the most common reason to initiate TOC (81.6%), while the lack of TOC guidelines was perceived to be the greatest barrier (84.2%).
Conclusion: This study provides a better understanding of TOC from the point of view of paediatric surgeons in Malaysia. However, further studies involving other stakeholders (i.e. patients and adult surgeons) are needed to help formulate a suitable and successful TOC model in this setting.

Matched MeSH terms: Practice Guidelines as Topic
Fulltext Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Malik M, Hassali MA, Shafie AA, Hussain A

East Mediterr Health J, 2014 Apr;20(4):221-8.
PMID: 24952118

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers (97.7%) agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts.

Matched MeSH terms: Practice Guidelines as Topic
Determining optimal gestational weight gain in a multiethnic Asian population

Ee TX, Allen JC, Malhotra R, Koh H, Østbye T, Tan TC

J Obstet Gynaecol Res, 2014 Apr;40(4):1002-8.
PMID: 24611987 DOI: 10.1111/jog.12307

To define the optimal gestational weight gain (GWG) for the multiethnic Singaporean population.

Matched MeSH terms: Practice Guidelines as Topic
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: Practice Guidelines as Topic
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: Practice Guidelines as Topic
Sensitivity and specificity of visual clinical assessment as compared to WHO 2006 standard and NCHS 1977 reference in measuring the growth status of Malaysian infants

Selamat R, Zain F, Raib J, Zakaria R, Marzuki MS, Ibrahim TF

J Am Coll Nutr, 2011 Dec;30(6):522-8.
PMID: 22331687

OBJECTIVE: To study the validity of the visual clinical assessment of weight relative to length and length relative to age as compared to the World Health Organization (WHO) 2006 standard and National Center for Health Statistics (NCHS) 1977 reference in asssessing the physical growth of children younger than 1 year.
MATERIALS AND METHODS: A prospective cohort study was carried out among 684 infants attending goverment health clinics in 2 states in Malaysia. Body weight, length, and clinical assessment were measured on the same day for 9 visits, scheduled every month until 6 months of age and every 2 months until 12 months of age. All of the 3 z-scores for weight for age (WAZ), length for age (HAZ), and weight for length (WHZ) were calculated using WHO Anthro for Personal Computers software.
RESULTS: The average sensitivity and specificity for the visual clinical assessment for the detection of thinness were higher using the WHO 2006 standard as compared with using NCHS 1977. However, the overall sensitivity of the visual clinical assessment for the detection of thin and lean children was lower from 1 month of age until a year as compared with the WHO 2006 standard and NCHS 1977 reference. The positive predictive value (PPV) for the visual clinical assessment versus the WHO 2006 standard was almost doubled as compared with the PPV of visual clinical assessment versus the NCHS 1977 reference. The overall average sensitivity, specificity, PPV, and negative predictive value for the detection of stunting was higher for visual clinical assessment versus the WHO 2006 standard as compared with visual clinical assessment versus the NCHS 1977 reference.
CONCLUSION: The sensitivity and specificity of visual clinical assessment for the detection of wasting and stunting among infants are better for the WHO 2006 standard than the NCHS 1977 reference.

Matched MeSH terms: Guidelines as Topic
In-stent restenosis: the gold standard has changed

Chin K

EuroIntervention, 2011 May;7 Suppl K:K43-6.
PMID: 22027726 DOI: 10.4244/EIJV7SKA7

In-stent restenosis remains an important issue even in the drug-eluting stent (DES) era today. In recent years, drug-eluting balloons (DEB) have emerged as a potential alternative to the treatment of in-stent restenosis. Paclitaxel was identified as the primary drug for DEB because of its rapid uptake and prolonged retention. Non-stent-based local drug delivery using DEB maintains the antiproliferation properties of DES, but without the limitations of DES such as subacute stent thrombosis, stent fractures, prolonged antiplatelet therapy and more importantly, avoiding a "stent-in-a-stent" approach. The first major impact of drug-eluting balloon (DEB) in the management of bare metal instent restenosis was the "PACCOCATH ISR I" randomised trial, comparing the efficacy of drug-eluting balloon versus uncoated balloon. The six months angiographic results showed a binary restenosis of 5% and 4% MACE in the drug-eluting balloon group, compared with 43% binary restenosis and 31% MACE, in the uncoated balloon group (p=0.002 and 0.02). The second major DEB trial is the "PEPCAD II Trial", comparing the efficacy of the SeQuent Please DEB with the Taxus drug-eluting stent in the treatment of bare-metal stent instent restenosis. At 6-month follow-up, in-segment late lumen loss was 0.38 ± 0.61 mm in the DES group versus 0.17 ± 0.42 mm (p=0.03) in the DEB group, resulting in a binary restenosis rate of 12/59 (20%) versus 4/57 (7%; p=0.06). At 12 months, MACE rates were 22% in the Taxus group and 9% in the DEB group (P=0.08). The TLR at 12 months was 15% in the Taxus group and 6% in the DEB group (p=0.15). Based on these two pivotal trials, the European Society of Cardiology Guidelines for Percutaneous Coronary Intervention (2010) recommended that DEB should be considered for the treatment of in-stent restenosis after prior bare-metal stent. This was accorded a class 2 IIa indication, with a level B evidence.

Matched MeSH terms: Practice Guidelines as Topic
Effectiveness of medical nutrition treatment delivered by dietitians on glycaemic outcomes and lipid profiles of Arab, Omani patients with Type 2 diabetes

Al-Shookri A, Khor GL, Chan YM, Loke SC, Al-Maskari M

Diabet Med, 2012 Feb;29(2):236-44.
PMID: 21824187 DOI: 10.1111/j.1464-5491.2011.03405.x

In this randomized controlled trial we evaluated the effectiveness of medical nutritional therapy on Arab patients with Type 2 diabetes in Oman delivered by a dietitian.

Matched MeSH terms: Practice Guidelines as Topic
Negative impact of chemotherapy on breast cancer patients QOL - utility of antiemetic treatment guidelines and the role of race

Hassan BA, Yusoff ZB

Asian Pac J Cancer Prev, 2010;11(6):1523-7.
PMID: 21338191

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) is one of the most important worries of cancer patients. Although not life-threatening, it has a great negative impact on quality of life (QOL).
OBJECTIVE: The aim of this study was to determine the impact of CINV (i.e., acute and delayed) on breast cancer patients QOL and to discern opinions related with antiemetic guidelines used dependent on the three main races in Malaysia (Malay, Chinese, Indian).
METHODS: In this longitudinal prospective observational study, 158 breast cancer patients treated with chemotherapy were interviewed and valid questionnaires (MANE and ONEM) were used to report the impact of CINV on their QOL within the first 24 hours and after 3 to 5 days of chemotherapy treatment.
RESULTS: The main result was that delayed CINV has an impact on QOL greater than acute CINV. The impact of nausea was reportedly higher than that of vomiting. Also differences in race i.e., genetic polymorphisms (pharmacogenomics) influenced the utility of antiemetic treatments and patients opinions.
CONCLUSION: Based on the results of our study a new guideline for antiemetic treatment should be used to reduce the impact of CINV on QOL, taking into account variation in genetic polymorphisms among the three races in Malaysia.

Matched MeSH terms: Guidelines as Topic
A prospective study on the pattern of medication use for schizophrenia in the outpatient pharmacy department, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia

Ponto T, Ismail NI, Abdul Majeed AB, Marmaya NH, Zakaria ZA

Methods Find Exp Clin Pharmacol, 2010 Jul-Aug;32(6):427-32.
PMID: 20852752 DOI: 10.1358/mf.2010.32.6.1477907

Schizophrenia is a chronic psychiatric disorder and pharmacotherapy plays a major role in its management. The 1950s and early 1960s saw milestones in the introduction of psychotropic drugs in clinical practice. A review of drug prescriptions in different settings provides an insight into the pattern of drug use, identifies drug-related problems and may be used to compare recommended guidelines with actual practice. This effort led to the evaluation of the drug prescribing pattern of antipsychotics in patients attending the psychiatric clinic at a government hospital. The data from 371 antipsychotic medication prescriptions that included 200 prescriptions for schizophrenia were collected during one month (1rst-31rst August 2008) at the outpatient pharmacy department. The mean age of patients was 35.0 years (SD = 1.131), with a male to female ratio of 2:1. The most widely used oral antipsychotic was haloperidol (16.3%) while the most common depot preparation prescribed was zuclopenthixol decanoate (8.8%). The daily dose of the average antipsychotic prescribed in this clinic was 342.06 mg equivalent of chlorpromazine. There was no relation between the doses received and ethnicity of the patient (Malay, Chinese or Indian). However, there was a significant relationship between the prescribed dose and patient age (P < 0.042). Nearly 32% of the schizophrenia patients were prescribed with atypical antipsychotics such as olanzapine (10.8%), risperidone (10.0%), quetiapine (7.6%) and clozapine (3.2%). Monotherapy was given to 73.0% of the schizophrenia patients. The majority of patients also received antidepressants. To conclude, this study gave evidence that physicians had a strong preference for monotherapy with conventional antipsychotic drugs while the use of atypical drugs was less prevalent.

Matched MeSH terms: Practice Guidelines as Topic
The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia

Siow JY, Lai PS, Chua SS, Chan SP

Int J Pharm Pract, 2009 Oct;17(5):305-11.
PMID: 20214273

In recent years, the usage of activated vitamin D (alpha-calcidol and calcitriol) in the University Malaya Medical Centre (UMMC) has escalated and this has put unnecessary burden on the hospital's limited health care budget. The main aim of this study was to determine the effects of a clinical pharmacist's intervention in reducing the inappropriate use of activated vitamin D.

Matched MeSH terms: Practice Guidelines as Topic
The development and comprehensibility of a pictorial asthma action plan

Roberts NJ, Mohamed Z, Wong PS, Johnson M, Loh LC, Partridge MR

Patient Educ Couns, 2009 Jan;74(1):12-8.
PMID: 18789626 DOI: 10.1016/j.pec.2008.07.049

OBJECTIVE: Written action plans are regarded as an important part of asthma self-management education and yet they may not be understood by those with limited literacy skills. This study was designed to produce an understandable pictorial asthma action plan.
METHODS: With advice from a group of doctors and nurses a "standard" written action plan was translated by a medical artist into a series of pictorial images. These were assessed using the techniques of guessability and translucency by a series of adults attending a specialist asthma clinic in London and the same process was subsequently used to assess comprehensibility of the images and plans amongst a group of Somalis living in Manchester, UK and Malaysians in Seremban, Malaysia.
RESULTS: Guessability testing showed that the majority of pictograms were well understood by each of the study groups. Translucency testing revealed close agreement with intended meaning for the majority of the images. One image, depicting extra use of reliever medication scored less well in all populations; two other images scored less well in the Somali and Malaysian groups and reflect less use of certain inhaler devices in other countries. The overall plan was well understood by all patients who were able to adequately recount the appropriate actions to take in different clinical scenarios.
CONCLUSION: We have developed a pictorial asthma action plan understandable by 3 different populations of patients with asthma.
PRACTICE IMPLICATIONS: Pictorial representations have been shown by other studies in other situations to be an effective method of reinforcing the spoken word. The pictorial asthma action plan developed for this study has been shown to be comprehensible, personalised to the individual in the usual fashion. It is now suitable for further evaluation in clinical practice.
Study site in Malaysia: Asthma clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Practice Guidelines as Topic
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: Practice Guidelines as Topic
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: Practice Guidelines as Topic
Fulltext Prognostic capabilities of coronary computed tomographic angiography before non-cardiac surgery: prospective cohort study

Sheth T, Chan M, Butler C, Chow B, Tandon V, Nagele P, et al.

BMJ, 2015;350:h1907.
PMID: 25902738 DOI: 10.1136/bmj.h1907

To determine if coronary computed tomographic angiography enhances prediction of perioperative risk in patients before non-cardiac surgery and to assess the preoperative coronary anatomy in patients who experience a myocardial infarction after non-cardiac surgery.

Matched MeSH terms: Practice Guidelines as Topic
Interests and policies of the state of Sarawak, Malaysia regarding intellectual property rights for plant derived drugs

Chung FJ

J Ethnopharmacol, 1996 Apr;51(1-3):201-4.
PMID: 9213617

Sarawak, on the island of Borneo, is known internationally for its rich rain forests, flora and fauna. Its rain forests, occupying two-thirds of its geographical area shelters 2500 tree species, 5500 flowering plants and over 20 000 different kinds of animals and insects. Such abundance of plants, and in particular, in the variety thereof, have attracted the attention of scientists involved in the field of research into their potential medicinal value. Recent discovery that two species of Calophyllum tree in the rain forests of Sarawak produce active anti-HIV agents, has, no doubt, intensified interest in the State's plant resources for scientific research.

Matched MeSH terms: Guidelines as Topic
Fulltext Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding

Lee YY, Tee HP, Mahadeva S

World J Gastroenterol, 2014 Feb 21;20(7):1790-6.
PMID: 24587656 DOI: 10.3748/wjg.v20.i7.1790

Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis.

Matched MeSH terms: Practice Guidelines as Topic
Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong CL, Buising K, Richards M, Robertson M, Street A

Intern Med J, 2006 Jan;36(1):37-42.
PMID: 16409311

BACKGROUND: Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index.
AIM: To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors.
METHODS: This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg.
RESULTS: A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines.
CONCLUSION: Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.

Matched MeSH terms: Practice Guidelines as Topic
Fulltext The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, et al.

J Subst Abuse Treat, 2016 07;66:37-47.
PMID: 27211995 DOI: 10.1016/j.jsat.2016.03.003

Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.

Matched MeSH terms: Practice Guidelines as Topic
Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis

Sabatino A, Regolisti G, Karupaiah T, Sahathevan S, Sadu Singh BK, Khor BH, et al.

Clin Nutr, 2017 06;36(3):663-671.
PMID: 27371993 DOI: 10.1016/j.clnu.2016.06.007

BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW.
METHODS: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis.
RESULTS AND CONCLUSION: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.

Matched MeSH terms: Practice Guidelines as Topic

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links