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  1. Hazwanie Hashim, Chong, David W.K., Hui, Meng Er, Pei, Se Wong, Mun, Sun Lee, Maharajan, Mari Kannan, et al.
    MyJurnal
    Background: Problem based learning (PBL) is both a constructivist pedagogic philosophy and an
    instructional format for promoting contextual, co-operative and self-directed learning; it is traditionally
    conducted as face-to-face tutorials. This study explored the utility of the live online chat application
    Google Hangouts, which we refer to as LOVE-PBL, for running synchronous PBL tutorials that
    included participants in different locations. Method: Data were collected from student participants
    using a mixed-methods approach, comprising a self-administered questionnaire and focus groups.
    We evaluated student participants’ perceptions of their learning experience and the effectiveness
    of online PBL via Google Hangouts. Results: More than 70% of participants agreed that learning
    outcomes were met using the Google Hangouts platform, and 50% felt that the ability to record the
    sessions was useful for learning and reflection. The major factors for effective online PBL were reliable
    internet connectivity, a conducive environment, and technical familiarity with the chat application
    and its functionality. Conclusion: Although online discussions do not fully equate to face-to-face
    conversations with regard to utility and enjoyment, learning outcomes are not compromised. Online
    chat applications thus extend the utility of PBL, and their use adds to the accessibility, flexibility and
    convenience that learners expect of higher education in a digital age.
  2. Lee EL, Wong PS, Tan MY, Sheridan J
    Int J Pharm Pract, 2018 Apr;26(2):138-147.
    PMID: 28574154 DOI: 10.1111/ijpp.12374
    OBJECTIVES: This study explored the experiences and views of individuals with type 2 diabetes mellitus (T2D) on their diabetes self-management and potential roles for community pharmacists in diabetes self-management education and support (DSME/S) in Malaysia.
    METHODS: A qualitative study, using semi-structured, face-to-face interviews, was conducted with patients with T2D attending a primary care health clinic in Kuala Lumpur, Malaysia. The interviews were audio-recorded, transcribed verbatim and analysed inductively.
    KEY FINDINGS: Fourteen participants with T2D were interviewed. Data were coded into five main themes: experience and perception of diabetes self-management, constraints of the current healthcare system, perception of the community pharmacist and community pharmacies, perceived roles for community pharmacists in diabetes care, and challenges in utilising community pharmacies to provide DSME/S. There were misconceptions about diabetes management that may be attributed to a lack of knowledge. Although participants described potential roles for community pharmacists in education, medication review and continuity of care, these roles were mostly non-clinically oriented. Participants were not confident about community pharmacists making recommendations and changes to the prescribed treatment regimens. While participants recognised the advantages of convenience of a community pharmacy-based diabetes care service, they raised concerns over the retail nature and the community pharmacy environment for providing such services.
    CONCLUSION: This study highlighted the need to improve the care provision for people with T2D. Participants with T2D identified potential, but limited roles for community pharmacists in diabetes care. Participants expressed concerns that need to be addressed if effective diabetes care is to be provided from community pharmacies in Malaysia.
    Study site: primary care health clinic (klinik kesihatan), Kuala Lumpur, Malaysia
  3. Shanmugham S, Lee EL, Kumar S, Zuber M, Noreen N, Smales FC, et al.
    Int Urol Nephrol, 2024 Aug 16.
    PMID: 39150601 DOI: 10.1007/s11255-024-04184-5
    PURPOSE: The use of topical corticosteroids (TCSs) has become an efficient, less-invasive treatment for phimosis. Whether any significant difference in efficacy exists between TCSs based on their potency is unclear.

    METHODS: Electronic databases were searched up to March 2024 for randomised controlled trials (RCTs) comparing the use of any type or concentration of TCSs with placebo or no treatment in boys with any degree of physician diagnosed phimosis. A random-effects network meta-analysis (NMA) using a consistency model within a frequentist approach was employed. The primary outcome was partial or complete resolution of phimosis reported as a pooled risk ratio (RR) with 95% CI. Relative ranking was assessed with surface under the cumulative ranking curve (SUCRA) probabilities.

    RESULTS: Seventeen RCTs, containing 2057 participants were identified. NMA suggested that, compared with control, the high (RR 3.19 (95% CI 1.42 to 7.16), moderate (RR 2.68 (95% CI 1.87 to 3.83) and low (RR 3.05 (95% CI 1.63 to 5.71) potency TCSs statistically significantly increased complete or partial clinical resolution of phimosis. The SUCRA plot revealed that high potency (SUCRA = 0.76) was ranked first followed by low and moderate TCSs. When we assessed comparative efficacy among TCSs based on potency, none of the classes were superior to others. The certainty of the evidence for an effect of moderate potent TCSs was that of moderate GRADE quality.

    CONCLUSION: Moderate to low potency TCSs are of comparable therapeutic effect in the treatment of phimosis to that of highly potent formulations. More high-quality RCTs are warranted.

  4. Mai CW, Sridhar SB, Karattuthodi MS, Ganesan PM, Shareef J, Lee EL, et al.
    BMJ Open, 2024 Nov 05;14(11):e087064.
    PMID: 39500605 DOI: 10.1136/bmjopen-2024-087064
    INTRODUCTION: Pharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.

    AIMS: To systematically review the current state of PGx in the primary care settings and determine the enablers and challenges of its implementation.

    DESIGN: A scoping review was carried out by adhering to Arksey and O'Malley's 6-stage methodological framework and the 2020 Joanna Briggs Institute and Levac et al. DATA SOURCES: Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed were searched up to 17 July 2023.

    ELIGIBILITY CRITERIA: All peer-reviewed studies in English, reporting the enablers and the challenges of implementing PGx in the primary care settings were included.

    DATE EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data. Information was synthesised based on the reported enablers and the challenges of implementing PGx testing in the primary care settings. Information was then presented to stakeholders for their inputs.

    RESULTS: 78 studies discussing the implementation of PGx testing are included, of which 57% were published between 2019 and 2023. 68% of the studies discussed PGx testing in the primary care setting as a disease-specific themes. Healthcare professionals were the major stakeholders, with primary care physicians (55%) being the most represented. Enablers encompassed various advantages such as diagnostic and therapeutic benefits, cost reduction and the empowerment of healthcare professionals. Challenges included the absence of sufficient scientific evidence, insufficient training for healthcare professionals, ethical and legal aspects of PGx data, low patient awareness and acceptance and the high costs linked to PGx testing.

    CONCLUSION: PGx testing integration in primary care requires increased consumer awareness, comprehensive healthcare provider training on legal and ethical aspects and global feasibility studies to better understand its implementation challenges. Managing high costs entails streamlining processes, advocating for reimbursement policies and investing in research on innovation and affordability research to improve life expectancy.

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