METHODS: We matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.
RESULTS: The utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.
CONCLUSIONS: Understanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.
METHODS: This study included participants from the intervention arm of a randomised controlled trial which was conducted to evaluate the effects of pharmacist-led interventions on CML patients treated with TKIs. Participants were recruited and followed up in the haematology clinics of two hospitals in Malaysia from March 2017 to January 2019. A pharmacist identified DRPs and helped to resolve them. Patients were followed-up for six months, and their DRPs were assessed based on the Pharmaceutical Care Network Europe Classification for DRP v7.0. The identified DRPs, the pharmacist's interventions, and the acceptance and outcomes of the interventions were recorded. A Poisson multivariable regression model was used to analyse factors associated with the number of identified DRPs per participant.
RESULTS: A total of 198 DRPs were identified from 65 CML patients. The median number of DRPs per participants was 3 (interquartile range: 2, 4). Most participants (97%) had at least one DRP, which included adverse drug events (45.5%), treatment ineffectiveness (31.5%) and patients' treatment concerns or dissatisfaction (23%). The 228 causes of DRPs identified comprised the following: lack of disease or treatment information, or outcome monitoring (47.8%), inappropriate drug use processes (23.2%), inappropriate patient behaviour (19.9%), suboptimal drug selection (6.1%), suboptimal dose selection (2.6%) and logistic issues in dispensing (0.4%). The number of concomitant medications was significantly associated with the number of DRPs (adjusted Odds Ratio: 1.100; 95% CI: 1.005, 1.205; p = 0.040). Overall, 233 interventions were made. These included providing patient education on disease states or TKI-related side effects (75.1%) and recommending appropriate instructions for taking medications (7.7%). Of the 233 interventions, 94.4% were accepted and 83.7% were implemented by the prescriber or patient. A total of 154 DRPs (77.3%) were resolved.
CONCLUSIONS: The pharmacist-led interventions among CML patients managed to identify various DRPs, were well accepted by both TKI prescribers and patients, and had a high success rate of resolving the DRPs.
OBJECTIVE: This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app.
METHODS: We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components.
RESULTS: Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04).
CONCLUSIONS: Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population.
METHODS: We conducted a systematic review searching MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and PsycINFO for studies published from January 2000 to March 2019. Reference lists and conference proceedings were hand-searched. Observational and intervention studies were eligible for inclusion. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool. Meta-analyses were conducted using random-effects models.
RESULTS: Of 13 373 records identified, 11 studies from Australia, Europe, Malaysia and the United States were included. All studies had at least a serious risk of bias, largely due to confounding and selection bias, making it difficult to draw causal conclusions from the evidence. Ten studies provided data on the association between current OAT use and recent HIV testing. Six showed a positive association, while four provided little evidence of an association: pooled odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.28-2.27. Looking at having ever been on OAT and having ever been HIV tested, seven studies showed a positive association and three showed either weak or no evidence of an association: pooled OR = 3.82, 95% CI = 2.96-4.95.
CONCLUSIONS: Opioid agonist therapy may increase uptake of HIV testing among people who inject drugs, providing further evidence that opioid agonist therapy improves the HIV treatment care cascade.
METHODS: Ten ligands with reported in vitro and/or in vivo activities against GAPDH were evaluated for their binding interactions through molecular docking studies using AutoDock 4.2 program. The ligand with the best binding energy was then modified to produce 10 derivatives, which were redocked against GAPDH using previous protocols. BIOVIA Discovery Studio Visualizer 2019 was used to explore the ligand-receptor interactions between the derivatives and GAPDH.
RESULTS: Among the 10 ligands, curcumin, koningic acid and folic acid showed the best binding energies. Further analysis on the docking of two folic acid derivatives, F7 (γ-{[tert-butyl-N-(6-aminohexyl)]carbamate}folic acid) and F8 (folic acid N-hydroxysuccinimide ester) showed that the addition of a bulky substituent at the carboxyl group of the glutamic acid subcomponent resulted in improved binding energy.
CONCLUSIONS: Folic acid and the two derivatives F7 and F8 have huge potentials to be developed as targeting agents against the GAPDH receptor. Further study is currently on-going to evaluate the effectiveness of these molecules in vitro.
OBJECTIVE: The aim of this systematic review and meta-analysis is to compare the effectiveness of amiodarone, dexmedetomidine and magnesium in preventing JET following congenital heart surgery.
METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, where 11 electronic databases were searched from date of inception to August 2020. The incidence of JET was calculated with the relative risk of 95% confidence interval (CI). Quality assessment of the included studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
RESULTS: Eleven studies met the predetermined inclusion criteria and were included in this meta-analysis. Amiodarone, dexmedetomidine and magnesium significantly reduced the incidence of postoperative JET [Amiodarone: risk ratio 0.34; I2= 0%; Z=3.66 (P=0.0002); 95% CI 0.19-0.60. Dexmedetomidine: risk ratio 0.34; I2= 0%; Z=4.77 (P<0.00001); 95% CI 0.21-0.52. Magnesium: risk ratio 0.50; I2= 24%; Z=5.08 (P<0.00001); 95% CI 0.39-0.66].
CONCLUSION: All three drugs show promise in reducing the incidence of JET. Our systematic review found that dexmedetomidine is better in reducing the length of ICU stays as well as mortality. In addition, dexmedetomidine also has the least pronounced side effects among the three. However, it should be noted that this conclusion was derived from studies with small sample sizes. Therefore, dexmedetomidine may be considered as the drug of choice for preventing JET.
METHODS: This case/control study was conducted in 2017 includes a control (donation oocytes) and two studies (PCO and POR) groups. The ovulation induction drugs were prescribed in all groups. After the oocyte puncture, the follicular fluid was collected and CCs were isolated were cultured. RNA was extracted and cDNA was synthesized and designed the primer for the ADR-α1, 2 and ADR-β2 gene expression. The protein levels were investigated by Western Blot.
RESULTS: The results showed a high level of three adrenergic expressions in PCO women compared to the control group (p-value
METHODS: review of thirty-nine public opinion surveys on the death penalty carried out in five Asian countries which retain the death penalty for drugs or are considering re-introducing it. The review was conducted by analysing and comparing design, methodology, findings, and the relationship between these elements.
RESULTS: all but two surveys recorded a majoritarian support for the death penalty, driven by beliefs in (a) deterrent effect of the death penalty, and (b) perfect justice - both disproven. Complex surveys found a low intensity of support, and a limited interest and knowledge by the public in capital punishment. Support for capital punishment is lower for drug offences specifically, and it decreases significantly when expressed with reference to real-life cases. Limited data suggest that the public in the focus countries has reservations on the effectiveness of the death penalty to reduce drug offences, and prefers a discretionary system of punishment. The analysis also revealed correlations between the framing of survey questions and their findings.
CONCLUSION: Public opinion surveys conducted in China, Malaysia, the Philippines, Singapore, and Thailand suggest that the public knows little and has little interest in the death penalty. Although majoritarian, its support is based on a faulty understanding of key facts related to capital punishment, and an increase in knowledge is correlated to a decrease in support. More rigorous polling exercises demonstrate that public support for capital punishment - both in general and for drug offences specifically - is instinctive, abstract, elastic, and contextual.
METHODS: Over 30,000 pages of documents have been accessed through the National Archives of Australia in Canberra. These have been photographed, scanned and converted to OCR. The most relevant folders have then been analysed through NVivo 12 to look for relevant mentions of the research question: capital punishment and Malaysia. All probative data is then presented in the article.
RESULTS: The data from National Archives suggests that the UN, Australia, and other western countries were happy to continue supporting Malaysia's drug policy and to elect it to high positions at UN meetings despite their public proclamations that they were opposed to the death penalty.
CONCLUSION: Applying a critical juncture approach, the article concludes that the 1980s was a critical juncture in the movement to abolish the death penalty but abolitionist countries allowed capital punishment to continue for drug offences. This may have set back the abolition movement by decades.