AIM: We aimed to find the role of pH-adjusted potassium (pHK ) in the development of hypokalemia, and their mutual impact on patient outcomes during DKA management.
METHODOLOGY: Adult DKA patient's admission data of preceding 3 years (2015-2017) were retrospectively clerked. Outcomes of interest were time to develop hypokalemia and to terminate emergency department (ED) care (hours), severity of hypokalemia and hospitalisation length (days). Linear regression was used to determine significant associations/predictors.
RESULTS: The study was concluded on 85 patients. Hypokalemia was observed in nearly 3/4th of all admissions and occurred by the time of ED care termination. Each 1 mmol/L increase in pHK significantly (a) reduced the degree of hypokalemia by 0.07 mmol/L, (b) delayed time to develop hypokalemia by 4.58 hours, (c) and reduced the ED care time by 1.28 hours. Arterial pH was the other factor significantly delaying time to develop hypokalemia (36.25 hours) and facilitating early discharge from ED (13.86 hours). Moreover, each 1 mmol/L reduction in the degree of hypokalemia increased hospitalisation length by 1.86 days. Though significant, acute kidney injury negligibly increased hospitalisation length by 0.01 days.
CONCLUSION: pH-adjusted potassium shall be used as a marker for hypokalemia and to initiate potassium replacement instead of measured serum potassium in DKA. Utilising pHK will help to avoid hypokalemia, reduce its severity and shorten ED care which will subsequently reduce hospitalisation length. We expect pHK to improve pharmacoeconomics in the future.
OBJECTIVE: This study aims to examine community pharmacists' views on their work environment, policies and preparedness for safe retail patronage to prevent the transmission of COVID-19 and assess the variables influencing coping strategies during the pandemic.
SETTING: An online survey of pharmacists practising in community pharmacy setting in Malaysia.
METHOD: A questionnaire-based, cross-sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilising a snowball sampling method.
MAIN OUTCOME MEASURE: Community pharmacists' perceptions on safety, resilience, organisational support, and pharmaceutical services offered during COVID-19 pandemic.
RESULTS: A total of 217 pharmacists participated in the study. The vast majority of community pharmacists reported a positive outlook and were able to balance working with self-care during this period. Most reported to have access to personal protective equipment such as gloves and hand sanitisers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb-side or drive-through delivery and pickup services.
CONCLUSION: The findings suggest the frontline and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.
OBJECTIVE: To systematically review the literature regarding the knowledge, attitudes and practice of community pharmacists in managing oral healthcare problems.
METHODS: A systematic review was conducted through Scopus, PubMed and Google Scholar databases. Studies regarding knowledge, attitudes and practice of management of dental care by community pharmacists between 1990 and 2019 were included.
RESULTS: Forest plot was performed to access knowledge, attitudes and practice of community pharmacist on oral healthcare. The results showed there were 44% of community pharmacists have a lack of knowledge on oral healthcare to provide an appropriate recommendation to patients with dental problems. Eighty-eight per cent of community pharmacists were willing to improve their knowledge of oral healthcare. There were 86% of them recognised that their role was significant in oral health. However, there were 59% of community pharmacists who had poor attitude in providing oral health information.
CONCLUSIONS: Community pharmacists were lacking knowledge on oral health mainly because of paucity in providing appropriate training courses. This has led to poor practices towards oral healthcare as they were unable to provide suitable products recommendations to the patients. This has led the community pharmacists into lack of attitudes in providing oral health information. However, most of the community pharmacists were conscious of their role in the oral healthcare system and were willing to improve their knowledge of oral healthcare.
METHODS: A total of 138 patients aged between 18 and 65 years old with the American Society of Anesthesiologists (ASA) I or II status, who required general anaesthesia and had no contraindication towards the use of P-LMA™, were recruited. They were randomly positioned into three anatomical landmarks, which were umbilicus, lowest rib margin, and xiphoid. P-LMA™ was inserted following muscle paralysis, and the first successful placement was evaluated using positional and performance tests. Duration, ease of P-LMA™ insertion, and airway complications were compared.
RESULTS: Demographic and airway features were comparable among all groups. The P-LMA™ placement success rate improved when the table height was positioned at the lowest rib margin (p=0.002). All three positions were comparable in terms of duration, ease of insertion, and airway morbidities.
CONCLUSION: The lowest rib margin anatomical landmark can be used as a guide in achieving the optimal operating table height for successful P-LMA™ placement.
MATERIALS AND METHODS: A prospective cross-sectional study was carried out to evaluate the prescribing, and dispensing errors in outpatients who seek patient counseling at the tertiary care multispecialty hospital. The data were collected from various sources such as patient's prescriptions and dispensing records from the pharmacy.
RESULTS: A total of 500 prescriptions were screened and identified 65.60% of prescriptions with at least any one type of medication errors. Out of 328 prescriptions, 96.04% were handwritten and 3.96% were computerised prescriptions. Among the 328 prescriptions with medication errors, 32.62% noticed prescribing errors, 37.80% with dispensing errors, and 29.58% with both prescribing and dispensing errors. Out of these 328 prescriptions, 74.09% prescriptions were found to have polypharmacy.
DISCUSSION: Medication errors are serious problems in healthcare and can be a source of significant morbidity and mortality in healthcare settings. The present study showed that dispensing errors were the most common among the types of medication errors, in these particularly wrong directions were the most common types of errors.
CONCLUSION: This study concludes that the overall prevalence of medication errors was around 80%, but there were no life-threatening events observed. A clinical pharmacist can play a major role in this situation appears to be a strong intervention and early detection and prevention of medication errors and thus can improve the quality of care to the patients.
OBJECTIVE: To evaluate the potential relationship between falls and diabetes in older persons and identify differences in risk factors of falls among older persons with and without diabetes using the first wave dataset of the Malaysian Elders Longitudinal Research (MELoR) study.
METHODOLOGY: Community dwelling adults aged ≥ 55 years were selected through stratified random sampling from three parliamentary constituencies in greater Kuala Lumpur. Baseline data was obtained through computer-assisted, home-based interviews. The presence of falls was established by enquiring about falls in the preceding 12 months. Diabetes was defined as self-reported, physician-diagnosed diabetes, diabetes medication use and an HbA1c of ≥ 6.3%.
RESULTS: Diabetes was present in 44.4% of the overall 1610 participants. The prevalence for fall among older diabetics was 25.6%. Recurrent falls (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.06-2.57) was more common among diabetics. Following adjustment for potential confounders, osteoporosis (OR 2.58; 95% CI 1.31-5.08) and dizziness (OR 1.50; 95% CI 1.01-2.23) were independent risk factors for falls. Better instrumental activities of daily living scores were protective against falls (OR 0.75; 95% CI 0.58-0.97).
CONCLUSION: The presence of osteoporosis and dizziness was associated with an increased risk of falls among older diabetics. These findings will need to be confirmed in future prospective follow-up of this cohort.
METHODS: We conducted a cross-sectional study on 140 hypertensive patients attending outpatient follow-up in two primary care clinics in Sungai Buloh, Malaysia, using a convenient sampling method. SUA levels were measured and divided into four quartiles. Two radiologist specialists performed B mode ultrasonography to assess the thickness of the right and left carotid intima media in all participants.
RESULTS: Participants' mean SUA level was 355.75 ± 0.13. Their mean age was 53.44 (± 9.90), with a blood pressure control of 137.09 ± 13.22/81.89 ± 8.95. Elevated CIMT taken at ≥75th percentile was 0.666 for the left and 0.633 for the right common carotid arteries. By using a hierarchical method of multiple logistic regression, compared with the first quartile of the SUA level as reference group, the odd of elevated CIMT in quartile 4 in the common carotid artery was (OR = 2.00; 95% CI = 0.64-6.27, P = .576) for the right and (OR = 0.62; 95% CI = 0.20-2.00, P = .594) for the left. Waist circumference (P = .001), body mass index (P = .013), triglycerides (P