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Fulltext The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

Al Aqqad SM, Chen LL, Shafie AA, Hassali MA, Tangiisuran B

Clin Interv Aging, 2014;9:201-7.
PMID: 24489461 DOI: 10.2147/CIA.S52356

Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents.
Fulltext Does educational intervention improve doctors' knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia

Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Mohamad Yahaya AH, Aljadhey H

SAGE Open Med, 2014;2:2050312114555722.
PMID: 26770747 DOI: 10.1177/2050312114555722

To investigate the impact of an educational intervention on doctors' knowledge and perceptions towards generic medicines and their generic (international non-proprietary name) prescribing practice.
Fulltext Adverse drug reactions reporting : Knowledge and opinion of general public in Penang, Malaysia

Elkalmi R, Hassali MA, Al-Lela OQ, Jawad Awadh AI, Al-Shami AK, Jamshed SQ

J Pharm Bioallied Sci, 2013 Jul;5(3):224-8.
PMID: 24082699 DOI: 10.4103/0975-7406.116824

The objective of this study was to explore the knowledge of the general population towards ADR and their reporting system.
Fulltext A cross-sectional assessment of knowledge, attitude and practice among Hepatitis-B patients in Quetta, Pakistan

ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Haseeb A, et al.

BMC Public Health, 2013;13:448.
PMID: 23641704 DOI: 10.1186/1471-2458-13-448

Hepatitis-B is a life threatening infection resulting in 0.6 million deaths annually. The prevalence of Hepatitis-B is rising in Pakistan and furthermore, there is paucity of information about Knowledge, Attitude and Practice among Hepatitis-B patients. Better disease related knowledge is important to have positive attitude and that will bring the good practices which will prevent the further spread of infection. This study aimed to evaluate knowledge, attitude and practice of Hepatitis-B Patients in Quetta city, Pakistan.
Fulltext Patterns and predictors of non-prescription medicine use among Malaysian pharmacy patrons: a national cross sectional study

Hassali MA, Mohamad Yahaya AH, Shafie AA, Saleem F, Chua GN, Aljadhey H

PLoS One, 2013;8(4):e59231.
PMID: 23573195 DOI: 10.1371/journal.pone.0059231

The study aims to evaluate the predictors of non-prescription medicine purchasing patterns among pharmacy patrons in Malaysia.
Knowledge attitude and perception of dispensing doctors regarding generic medicines in Karachi, Pakistan: a qualitative study

Jamshed SQ, Hassali MA, Ibrahim MI, Babar ZU

J Pak Med Assoc, 2011 Jan;61(1):80-3.
PMID: 22368910
Complementary and Alternative Medicine (CAM) use by Malaysian oncology patients

Farooqui M, Hassali MA, Abdul Shatar AK, Shafie AA, Seang TB, Farooqui MA

Complement Ther Clin Pract, 2012 May;18(2):114-20.
PMID: 22500849 DOI: 10.1016/j.ctcp.2011.09.003

The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments.
Disease related knowledge and quality of life: a descriptive study focusing on hypertensive population in Pakistan

Saleem F, Hassali MA, Shafie AA, Atif M, Ul Haq N, Aljadhey H

South Med Rev, 2012 Jul;5(1):47-52.
PMID: 23093899

This study aims to evaluate association between Health related quality of lifeand disease state knowledge among hypertensive population of Pakistan.
Assessment of general public perceptions toward traditional medicines used for aphrodisiac purpose in state of Penang, Malaysia

Hassali MA, Saleem F, Shafie AA, Al-Qazaz HK, Farooqui M, Aljadhey H, et al.

Complement Ther Clin Pract, 2012 Nov;18(4):257-60.
PMID: 23059442 DOI: 10.1016/j.ctcp.2012.06.001

The study aims to evaluate general public perceptions regarding the use of Traditional and Complementary Medicines (TCM) for aphrodisiac purposes. A questionnaire based, cross-sectional study was undertaken. Respondents were selected in the state of Penang, Malaysia. A total of 392 respondents were included in the study. Descriptive statistics were used for data analysis. Chi Square/Fischer Exact tests were used where appropriate. Out of 392 respondents, 150 (38.26%) reported using specific Traditional medicines for aphrodisiac purposes. Most respondents (46.94%) agreed that aphrodisiac medicines were easily available t. Moreover, 40.31% of the respondents reported that traditional aphrodisiac medicines were cheaper than modern (prescription) medicines. This study highlights limited public knowledge regarding the use of traditional aphrodisiac medicine. Healthcare professionals should be aware of informal TCM usage when prescribing allopathic medicines.
Complementary and alternative medicines (CAM) disclosure to the health care providers: a qualitative insight from Malaysian cancer patients

Farooqui M, Hassali MA, Abdul Shatar AK, Shafie AA, Farooqui MA, Saleem F, et al.

Complement Ther Clin Pract, 2012 Nov;18(4):252-6.
PMID: 23059441 DOI: 10.1016/j.ctcp.2012.06.005

This study sought to evaluate Malaysian oncology patients CAM disclosure to the health care providers. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified three themes: reasons of CAM disclosure, reasons of CAM non-disclosure and preference of CAM discussion to health care providers. Patients agreed that CAM disclosure is important to avoid any interaction with the conventional medicines. Perceived lack of physicians' knowledge & interest in CAM, fear of termination of therapy by the physicians upon CAM disclosure, and perceived simplicity of some of the CAM therapies were among the reasons of non-disclosure. Given the option of oncologists, pharmacists or nurses, patients described oncologists as the most suitable person to discuss or disclose CAM use due to confidence in their clinical skills. Understanding the underlying beliefs of patients' reluctance to disclose CAM to health care providers is important especially when they are on an ongoing treatment for cancer.
Fulltext Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do?

Abdulameer SA, Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN

Patient Prefer Adherence, 2012;6:435-48.
PMID: 22791981 DOI: 10.2147/PPA.S32745

Diabetes mellitus (DM) is a pandemic and chronic metabolic disorder with substantial morbidity and mortality. In addition, osteoporosis (OP) is a silent disease with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the relationship between OP and type 2 diabetes mellitus (T2DM). Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases on the Universiti Sains Malaysia Library Database. The following keywords were used for the search: T2DM, OP, bone mass, skeletal. Studies of more than 50 patients with T2DM were included. Forty-seven studies were identified. The majority of articles (26) showed increased bone mineral density (BMD), while 13 articles revealed decreased BMD; moreover, eight articles revealed normal or no difference in bone mass. There were conflicting results concerning the influence of T2DM on BMD in association with gender, glycemic control, and body mass index. However, patients with T2DM display an increased fracture risk despite a higher BMD, which is mainly attributable to the increased risk of falling. As a conclusion, screening, identification, and prevention of potential risk factors for OP in T2DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients and decreasing the risk of fracture. Patients with T2DM may additionally benefit from early visual assessment, regular exercise to improve muscle strength and balance, and specific measures for preventing falls. Patient education about an adequate calcium and vitamin D intake and regular exercise is important for improving muscle strength and balance. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in diabetic patients.
Psychometric properties of Osteoporosis Knowledge Tool and self-management behaviours among Malaysian type 2 diabetic patients

Abdulameer SA, Syed Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN

J Community Health, 2013 Feb;38(1):95-105.
PMID: 22772955 DOI: 10.1007/s10900-012-9586-4

Osteoporosis is a major growing public health problem and it is clear that much needs to be done to bridge the gap between patients and practitioners. However, the educator must have a valid and reliable tool to evaluate the effectiveness of the teaching and learning that are done. Osteoporosis Knowledge Tool (OKT) provides an important strategy for healthcare professionals to start early intervention for patients who are at risk of osteoporosis. The aims of this study were to translate and examine the psychometric properties of the Malaysian version of the Osteoporosis Knowledge Tool (OKT-M) among 250 type 2 diabetes patients and to assess factors that affect diabetic patients' osteoporosis knowledge. The OKT English version was translated and validated using the internationally accepted and recommended methodology. The sensitivity and specificity of OKT-M was calculated using receiver operating characteristic curve analysis. The face and content validity showed acceptable results. Internal consistency, test-retest reliability, mean difficulty factor and discriminatory power values were 0.72, 0.83, 0.47 ± 0.16 and 0.96, respectively. The cut-off point of the OKT-M to predict osteoporosis/osteopenia was 14 with optimal sensitivity (84.1%) and specificity (85.5%). Regression analysis revealed that health belief, self-efficacy and some demographic data had an impact on the OKT-M. The findings of this validation study indicate that the OKT-M is a reliable and valid tool with good psychometric properties in the Malaysian setting. The OKT-M is an appropriate tool for application in clinical setting to identify patients need for a bone health-promoting intervention regarding lifestyle behaviour changes.
Perceptions among general medical practitioners toward implementation of medication reconciliation program for patients discharged from hospitals in Penang, Malaysia

Hassali MA, Al-Haddad M, Shafie AA, Tangiisuran B, Saleem F, Atif M, et al.

J Patient Saf, 2012 Jun;8(2):76-80.
PMID: 22561848 DOI: 10.1097/PTS.0b013e31824aba86

OBJECTIVE: This study aims to explore the perceptions of general practitioners (GPs) from the state of Penang toward the feasibility of implementing the medication reconciliation program in Malaysia.
METHODS: A cross-sectional descriptive study using a validated, self-completed anonymous 18-item questionnaire was undertaken over a period of 2 months in 2010. The study was conducted in the state of Penang, Malaysia. A letter consisting of survey questionnaires and prepaid return envelope were mailed to 429 GPs identified from the Private Medical Practice Control Department Registry.
RESULTS: A total of 86 responses were received with response rate of 20.1%. Majority (90.1%) of the respondents agreed that medication reconciliation can be a feasible strategy to improve medication safety, and 97.7% confirmed that having an accurate up-to-date list of the patient's previous medication will be useful in the rational prescribing process. However, about half (56.9%) of them felt that standardization of the medication reconciliation process in all clinics will be difficult to achieve. Three quarters (73.2%) of the respondents believed that the involvement of GPs alone is insufficient, and 74.5% agreed that this program should be expanded to community pharmacy setting. More than 90% of the respondents agreed upon the medication reconciliation card proposed by the researchers.
CONCLUSIONS: General practitioners in Penang are generally in favor of the implementation of medication reconciliation program in their practice. Because medication reconciliation has been shown to reduce many medicine-related problems, it is thus worth considering the feasibility of nationwide implementation of such program.
WHO guidelines for treatment of tuberculosis: the missing links

Atif M, Sulaiman SA, Shafie AA, Ali I, Hassali MA, Saleem F

Int J Clin Pharm, 2012 Aug;34(4):506-9.
PMID: 22706597 DOI: 10.1007/s11096-012-9657-8

Worldwide, the treatment of tuberculosis is based on evidence-based guidelines developed by the World Health Organization (WHO) for national tuberculosis programs. However, the importance of health related quality of life, the adequate management of side effects associated with antituberculosis drugs and the elaboration of tuberculosis treatment outcome categories are a few issues that need to be addressed in forthcoming WHO guidelines for the treatment of tuberculosis.
Self-medication practices among adult population attending community pharmacies in Malaysia: an exploratory study

Hassali MA, Shafie AA, Al-Qazaz H, Tambyappa J, Palaian S, Hariraj V

Int J Clin Pharm, 2011 Oct;33(5):794-9.
PMID: 21811832 DOI: 10.1007/s11096-011-9539-5

OBJECTIVE: To assess the prevalence of self-medication among adults in an urban setting and to identify any factors contributing to self-medication in relation to consumer characteristics.
SETTING: The study was carried out in Kuala Lumpur, the capital of Malaysia.
METHODS: A cross-sectional study using a self administered questionnaire including adults above 21 years old as an exit survey was conducted in Kuala Lumpur.
MAIN OUTCOME MEASURES: Number of medications taken in a day by participants, source of medication for the treatment of minor illnesses among participants, common illnesses chosen for self-medication by participants, and the sources of information of participants.
RESULTS: Of 314 participants, 62.7% had taken at least one medication in the past week without prescription and 62.7% believed that over the counter medicines were just as effective as those prescribed by doctors. 69.4% would seek a healthcare professional's advice before purchasing any medication and 86.9% would consult a pharmacist prior to buying medication from the pharmacy. Only 86% checked the expiry dates on medications and 54.5% reported keeping leftover medication.
CONCLUSIONS: Self-medication practice is prevalent in Kuala Lumpur but some practice might be harmful. Education on appropriate use of self-medication need to be emphasized in order to ensure quality use of medicines.
Fulltext Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia

Oh AL, Hassali MA, Al-Haddad MS, Syed Sulaiman SA, Shafie AA, Awaisu A

J Infect Dev Ctries, 2011 May;5(5):338-47.
PMID: 21628809

INTRODUCTION: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia.
METHODOLOGY: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009.
RESULTS: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold.
CONCLUSION: Educational interventions are needed to promote prudent use of antibiotics among the public.
Study site: outpatient pharmacy, Hospital Pulau Pinang, Malaysia
A survey evaluating nurses' perception and expectations towards the role of pharmacist in Pakistan's healthcare system

Azhar S, Hassali MA, Mohamed Ibrahim MI, Saleem F, Siow Yen L

J Adv Nurs, 2012 Jan;68(1):199-205.
PMID: 21658097 DOI: 10.1111/j.1365-2648.2011.05728.x

This paper is a report of a study of nurses' perception towards the role of pharmacist in Pakistan healthcare setup.
Tuberculous lymphadenitis at Penang General Hospital, Malaysia

Khan AH, Sulaiman SA, Muttalif AR, Hassali MA, Khan TM

Med Princ Pract, 2011;20(1):80-4.
PMID: 21160220 DOI: 10.1159/000319764

To evaluate the incidence, treatment and clinical outcomes of tuberculous (TB) lymphadenitis at Penang General Hospital, Malaysia.
Treatment patterns and outcomes in management of solid cancer patients suffering from thrombocytopenia in Penang hospital

Hassan BA, Yusoff ZB, Hassali MA, Bin Othman S

Asian Pac J Cancer Prev, 2011;12(11):2841-5.
PMID: 22393951

INTRODUCTION: Thrombocytopenia denotes abnormal decreases in platelet numbers and is a major detrimental side effect of the chemotherapy or cancer disease itself which cal lead to hemorrhage from vital organ. This is particularly a problem for the brain specifically within solid cancer patients and has a great negative effect on cancer patients quality of life (QOL). It ranges from mild bleeding from small blood vessels to severe bleeding from large blood vessels. The present study was conducted to evaluate the effectiveness of treatment guidelines for thrombocytopenia among solid cancer patients in Penang hospital and to find associations between these treatments and thrombocytopenia onset and severity and to suggest changes in the guidelines.
METHODS: This retrospective observational study, conducted in a government hospital on Penang island included 341 cancer patients with thrombocytopenia who were admitted in the period between 2003 to 2009. The main statistical tests used were Chi-square test and Logistic regression test. The level of significance was set at P < 0.05.
RESULTS: Of the total of 341, 21 (6.2%) showed thrombocytopenia before receiving chemotherapy and the remaining 320 (93.8%) after chemotherapy. The majority suffered from moderate thrombocytopenia (n=172; 53.8%), followed by mild a (n=97; 30.3%) and finally severe (n=51; 15.9%). For treatment, chemotherapy was delayed/ reduced (n=223; 65.4%) or platelets were transfused (n=51; 34.6%). However, thrombocytopenia problems were only temporarily solved.
CONCLUSION: Effectiveness of thrombocytopenia treatment guidelines was found to be insufficient. It is advisable that thrombopoietin be used as a cornerstone even for patients who suffer from moderate thrombocytopenia and platelets transfusion should be used just for emergency cases when thrombocytopenia leads to a critical situation.
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.

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