Displaying all 17 publications

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  1. Balan S
    Int J Pharm Pract, 2021 Aug 11;29(4):308-320.
    PMID: 34289016 DOI: 10.1093/ijpp/riab030
    OBJECTIVE: Healthcare professionals have an important role in ensuring that adverse drug reactions are well documented and reported. The key determinants of adverse drug reactions reporting are the knowledge, attitude and practice of healthcare professionals. A systematic review of the literature was undertaken to identify, critically evaluate and summarise the findings on the knowledge, attitude and practice of Malaysian healthcare professionals towards adverse drug reaction reporting.

    METHODS: Literature search using electronic databases including PubMed, Google Scholar and National Medical Research Register was conducted. Additional articles were identified by reviewing the bibliography of the retrieved articles. The articles were searched with any of the Medical Subject Headings (MeSH) terms in the title: adverse drug reaction, attitude, awareness, behaviour, experience, knowledge, Malaysia, perspectives, pharmacovigilance, practice and view. Studies were selected based on fulfilment of inclusion and exclusion criteria. The articles were scrutinised using thematic analysis.

    KEY FINDINGS: Nine studies conducted among doctors, pharmacists and nurses met the inclusion criteria. Five themes emerged which included knowledge, attitude, practice, barriers and facilitators of adverse drug reaction reporting among healthcare professionals.

    CONCLUSION: In general, healthcare professionals in Malaysia have good knowledge on and positive attitudes towards adverse drug reaction reporting. However, the practice of adverse drug reaction reporting was found to be unsatisfactory among healthcare professional in Malaysia. The approaches taken to enhance ADR reporting among Malaysian healthcare professionals should focus on alleviating lethargy and ignorance associated with ADR reporting.

  2. Sulaiman, I.M., HS, Lee, Balan, S., Jaafar, M.Z.
    Medicine & Health, 2006;1(1):20-24.
    MyJurnal
    Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L in Group 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significant.
  3. Ahmad N, Zanariah Y, Balan S
    Med J Malaysia, 2008 Dec;63(5):431-3.
    PMID: 19803312
    We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.
  4. Kaur S, Balan S
    Theor Med Bioeth, 2015 Oct;36(5):341-61.
    PMID: 26438122 DOI: 10.1007/s11017-015-9339-3
    The welfare and protection of human subjects is critical to the integrity of clinical investigation and research. Institutional review boards (IRBs) were thus set up to be impartial reviewers of research protocols in clinical research. Their main role is to stand between the investigator and her human subjects in order to ensure that the welfare of human subjects are protected. While there is much literature on the conflicts of interest (CIs) faced by investigators and researchers in clinical investigations, an area that is less explored is CIs that may affect members of IRBs during the institutional ethics review of clinical investigations. This article examines the notion of CIs in clinical research and attempts to develop a framework for a clearer and more balanced approach to identifying CIs that may influence members of IRBs and impede their independence. It will also apply the proposed framework to demonstrate how IRBs possess, or at least may appear to possess, forms of financial CIs and non-financial CIs. The proper identification and management of these CIs is critical to preserving the integrity of clinical investigations and achieving the primary aim of human subjects protection.
  5. Ahmad N, Tan CC, Balan S
    Med J Malaysia, 2007 Jun;62(2):122-6.
    PMID: 18705443 MyJurnal
    We sought to review the current practice of sedation and analgesia in intensive care units (ICUs) in Malaysian public hospitals. A questionnaire survey was designed and sent by mail to 40 public hospitals with ICU facility in Malaysia. The anaesthesiologists in charge of ICU were asked to complete the questionnaire. Thirty seven questionnaires were returned (92.5% response rate). Only 35% respondents routinely assess the degree of sedation. The Ramsay scale was used prevalently. A written protocol for sedation was available in only 14 centers (38%). Although 36 centers (95%) routinely adjust the degree of sedation according to patient's clinical progress, only 10 centers (14%) interrupt sedation on a daily basis. Most respondents agreed that the selection of agents for sedation depends on familiarity (97%), pharmacology (97%), the expected duration for sedation (92%), patient's clinical diagnosis (89%) and cost (73%). Midazolam (89%) and morphine (86%) were the most commonly used agents for sedation and analgesia, respectively. Only 14% respondents still frequently use neuromuscular blocking agents, mostly in head injury patients. Our survey showed similarity in the choice of sedative and analgesic agents in ICUs in Malaysian public hospitals comparable to international practice. Nevertheless, the standard of practice could still be improved by implementing the practice of sedation score assessment and daily interruption of sedative infusion as well as having a written protocol for sedation and analgesia.
  6. Tan CC, Zanariah Y, Lim KI, Balan S
    Med J Malaysia, 2007 Dec;62(5):370-4.
    PMID: 18705468
    Six hundred and fifty-five central venous catheters (CVC) in 496 patients in the intensive care unit of Hospital Sultanah Aminah were studied to determine the incidence and risk factors for central venous catheter-related blood stream infection (CR-BSI). CR-BSI was diagnosed in 38 catheters, giving an incidence of 9.43 CR-BSI per 1000 catheter days. The mean duration in situ was 8.4 +/- 4.9 days for infected CVCs and 6.0 +/- 3.8 days for non infected CVCs (p = 0.001). CVCs inserted in ICU had the highest infection rate (9.4%) compared to those inserted in the operating theatre (1.4%) and ward (2.8%) (p = 0.001). The highest rate of CR-BSI occurred with 4-lumen catheters (usually inserted when patients needed total parenteral nutrition) with a percentage of 15.8%. The majority of the CVCs (97.9%) were inserted via the subclavian or the internal jugular routes and there was no statistical difference in CR-BSI between them (p = 0.83). Number of attempts more than one had a higher rate of CR-BSI compared to single attempt with percentage of 7.0% vs 4.8% (p = 0.22). The top two organisms were Klebseilla pneumoniae and Pseudomonas aeruginosa. In conclusion, the incidence of CR-BSI in our ICU was 9.43 CR-BSI per 1000 catheter days. The risk factors were duration of CVC in situ, venue of insertion and use of 4 lumen catheter for total parenteral nutrition. The site of insertion, number of lumen up to 3 lumens and the number of attempts were not risk factors.
  7. Ganeswrie R, Chui CS, Balan S, Puthucheary SD
    Malays J Pathol, 2004 Dec;26(2):99-103.
    PMID: 16329561
    This study was carried out to compare the performance of BACTEC MGIT 960 with the BACTEC 460 TB for growth and detection of Mycobacteria from human clinical specimens. The BACTEC MGIT 960 instrument is a fully automated system that utilizes MGIT tubes containing an oxygen sensor embedded in silicon at the bottom and filled with 7 mL of modified Middlebrook 7H9 broth. Identical samples were inoculated into the two automated systems and incubated for six weeks. Over a period of three months, 279 specimens were decontaminated and processed according to the standard CDC NALC/NaOH method, using the commercial MycoPrep kit. Forty-two specimens (15%) yielded Mycobacterium tuberculosis; 37 (88%) were detected by the fluorescent BACTEC MGIT 960 and 35 (83%) detected by the radiometric BACTEC 460 TB. Fifteen specimens (5%) yielded Mycobacterium Other Than Tuberculosis (MOTT); 10 (66%) were detected by BACTEC MGIT 960 and 11 (73%) detected by BACTEC 460 TB. The average time to detection and contamination rates and the average time to obtain results of antimicrobial susceptibility tests between the two systems were compared. The performance of the BACTEC MGIT 960 was comparable to the BACTEC 460 TB system which has been the "Gold Standard" for automated detection of TB. The former was more rapid, as sensitive and less labour intensive than the BACTEC 460. Our data demonstrates that the BACTEC MGIT 960 system is an accurate, automated and a non-radioactive alternative to the BACTEC 460 TB for the culture and susceptibility testing of M. tuberculosis.
  8. Tan CC, Lee HS, Balan S
    Med J Malaysia, 2004 Dec;59(5):591-7.
    PMID: 15889560
    All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.
  9. Balan S, Hassali MA, Mak VS
    Br J Clin Pharmacol, 2015 Dec;80(6):1269-80.
    PMID: 26314841 DOI: 10.1111/bcp.12750
    AIM: The aim of this review was to provide an updated overview of awareness, knowledge and views of off-label prescribing in children.

    METHOD: A literature search using electronic databases including PubMed, Medline, Scopus, Science Direct, Springer Link, Proquest, Ebsco Host and Google Scholar was conducted. Additional articles were identified by reviewing the bibliography of retrieved articles. The articles were searched with any of the following medical subject headings (MeSH) terms in the title: attitude, awareness, knowledge, experience, view, off-label, pediatric, paediatric and children. The inclusion criteria were full text articles published in English between January 2004 and February 2015 and reported outcome related to awareness, knowledge and views regarding off-label prescribing in children. Editorials, reviews, notes, conference proceedings, letters and studies reporting prevalence of off-label prescribing were excluded. The articles were scrutinized using thematic analysis.

    RESULTS: Eleven studies conducted among doctors, community pharmacists, paediatric nurses, parents and children met the inclusion criteria. Nine themes were developed through document analysis which included main domains such as knowledge, awareness and views on off-label drug use in children, choice of information sources, reasons and suggestions to reduce off-label prescribing, concern regarding obtaining consent and participation in clinical trials.

    CONCLUSION: The studies reviewed reported that the majority of doctors and community pharmacists were familiar with the term off-label prescribing but knowledge among parents was low. Awareness on off-label prescribing in children remains low among all study participants. There is a mismatch between views on off-label prescribing in children of study participants and the finding of previous studies.

  10. Balan S, Hassali MA, Mak VSL
    Res Social Adm Pharm, 2017 May-Jun;13(3):653-655.
    PMID: 27493130 DOI: 10.1016/j.sapharm.2016.06.014
    The pediatric population is an enormously diverse segment of population varying both in size and age. The diversity caused pharmacists face various challenges primarily related to procuring, provision as well as use of drugs in this group of patients. Pediatric dose calculation is particularly a concern for pharmacists. Another challenge faced by pharmacists is unavailability of suitable formulations for pediatric use. This has also led many pharmacists to prepare extemporaneous liquid preparations, even though stability data on such preparations are scarce. Some extemporaneous preparations contain excipients which are potentially harmful in children. Besides that, inadequate labeling and drug information for pediatric drug use had not only challenged pharmacists in recommending and optimizing drug use in children, but also inadvertently caused many drugs used outside the approved terms of the product license (off-label use). Pharmacists are striving to stay connected to overcome the common and comparable challenges faced in their day to day duties and strive to maximize the safe and effective use of medicines for children.
  11. Balan S, Ahmad Hassali MA, Mak VSL
    Int J Clin Pharm, 2019 Aug;41(4):1074-1084.
    PMID: 31197546 DOI: 10.1007/s11096-019-00862-y
    Background Off-label prescribing in children is associated with several prerequisites such as ensuring sound and scientific evidence and obtaining written consent prior to use of off-label drugs to ensure that protection is provided to patients and healthcare professionals. Adherence to the pre-requisites depends on the attitude, views and knowledge of the pharmacists and doctors involved in this practice. Objective To explore the attitudes, knowledge and views on off-label prescribing in children among hospital-based pharmacists and paediatric doctors. Setting The study was conducted in a 620-bedded general hospital located in the urban area of central Peninsular Malaysia. Method Face to face, semi-structured interviews with 12 pharmacists and 12 paediatric doctors. Interviews were audio-recorded, transcribed and analysed using constant comparison method. Main outcome measure Themes surrounding hospital-based pharmacists' and paediatric doctors' attitude, knowledge and views on off-label prescribing in children. Results Four themes were derived: knowledge on off-label prescribing in children, views on off-label prescribing in children, attitude towards off-label prescribing in children and guidance on off-label prescribing in children. Conclusion There is a need to increase the knowledge of hospital-based pharmacists and paediatric doctors and address several concerns on off-label prescribing in children. The decision to prescribe or dispense off-label drugs involved collective decision-making mechanisms and guidance is required with regards to offlabel prescribing in children.
  12. Balan S, Hassali MAA, Mak VSL
    World J Pediatr, 2018 12;14(6):528-540.
    PMID: 30218415 DOI: 10.1007/s12519-018-0186-y
    BACKGROUND: In the past two decades, many legislative and regulatory initiatives were taken globally to improve drug use in children. However, children are still found to be prescribed with off-label drugs. This study was conducted to provide an overview of the worldwide trend in off-label prescribing in children from the year 1996 to 2016.

    DATA SOURCES: The articles published in PubMed, MEDLINE and Google Scholar were searched using text words: off-label, unlicensed, paediatric and children. Additional articles were identified by reviewing the bibliography of the retrieved articles. Full-text articles published in English which reported on the prevalence of off-label prescribing in children between January 1996 and December 2016 were included.

    RESULTS: A total of 101 studies met the inclusion criteria. Off-label prescribing definition included four main categories: age, indication, dose and route of administration. The three most common reference sources used in the studies were summary of product characteristics, national formularies and package inserts. Overall, the off-label prescribing rates in children ranged from 1.2 to 99.7%. The most common category of off-label prescribing in children was dose and age.

    CONCLUSIONS: This review highlighted that off-label prescribing in children was found to be highly prevalent throughout the past two decades, persistently in the neonatal intensive care units. This suggests that besides legislative and regulatory initiatives, behavioural, knowledge aspects and efforts to integrate evidence into practice related to off-label prescribing also need to be evaluated and consolidated as part of the concerted efforts to narrow the gaps in prescribing for children.

  13. Ahmad N, Choy CY, Aris EA, Balan S
    Anesth Analg, 2005 Apr;100(4):987-990.
    PMID: 15781511 DOI: 10.1213/01.ANE.0000147790.76114.3A
    We compared the efficacy of IV fentanyl with IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blind study we recruited 90 patients aged between 18 and 65 yr, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 3 groups: group F received 2 mL IV fentanyl 50 microg/mL (100 microg), group L received 2 mL of preservative-free lidocaine 2% (40 mg), and group P (placebo) received 2 mL of normal saline. The incidence of withdrawal response after rocuronium was 57%, 30%, and 7% in the placebo, lidocaine, and fentanyl groups, respectively. We found a significant reduction in incidence of withdrawal response in both the fentanyl and lidocaine groups when compared with the placebo group (P < 0.05), with the fentanyl group being most effective (P < 0.05). In conclusion, both fentanyl and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with fentanyl being more effective.
  14. Anas R, Rahman I, Jahizah H, Hassan A, Ezani T, Jong YH, et al.
    Med J Malaysia, 2008 Sep;63 Suppl C:78-80.
    PMID: 19227680
    The formulation of the Cardiothoracic Registry. Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax (the chest). It is a general treatment of conditions of the heart (heart disease) and lungs (lung disease). In Malaysia, due to lack of data collection we do not have estimates of number and outcome of such procedure in the country. Western figures are often used as our reference values and this may not accurately reflect our Malaysian population. The Malaysian Cardiothoracic Surgery Registry (MyCARE) by the Ministry of Health will be a valuable tool to provide timely and robust data of cardiology practice, its safety and cost effectiveness and most importantly the outcome of these patients in the Malaysian setting.
  15. Loh ZC, Hussain R, Balan S, Saini B, Muneswarao J, Ong SC, et al.
    PLoS One, 2023;18(4):e0283876.
    PMID: 37079594 DOI: 10.1371/journal.pone.0283876
    BACKGROUND: Short-acting β2-agonists (SABA), the most potent and rapid-acting relievers are commonly used to provide quick relief of asthma symptoms. However, there is an increasing concern regarding the misuse of SABA medicines.

    OBJECTIVE: This qualitative systematic review aims to determine, evaluate, and summarize the perceptions, attitudes, and behaviors towards the use of SABA from the patients' perspectives.

    METHODS: The databases searched included PubMed, Scopus, PsycINFO, CINAHL, and Cochrane database. Original research articles reporting the perceptions, attitudes, or behaviors of asthma patients towards the use of SABA, which was available as full text, published in the English language between the year 2000 and February 2023 were included in the review. Commentaries, letters to editor, review articles, and conference proceedings were excluded.

    RESULTS: A total of five articles were included. Six overarching themes were obtained: (1) perceptions on health status; (2) perceptions and attitudes towards the impact of asthma; (3) perceptions towards asthma control; (4) perceptions towards asthma knowledge; (5) risk perceptions; (6) perceptions, attitudes, and behaviors towards the use of SABA.

    CONCLUSION: Despite the fact that SABA could rapidly alleviate asthma symptoms, SABA over-users were less likely to describe their health status and asthma control as 'excellent'. Most SABA over-users did not know that frequent SABA usage would worsen their asthma control, and they exhibited psychological linkage towards the use of SABA. Collaborative efforts between policymakers, healthcare professionals and patients are warranted to reconstruct SABA prescribing practice and usage.

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