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Cost-Effectiveness of Clinical Pharmacy Education on Infection Management among Patients with Chronic Kidney Disease in an Indonesian Hospital

Nasution A, Syed Sulaiman SA, Shafie AA

Value Health Reg Issues, 2013 May;2(1):43-47.
PMID: 29702851 DOI: 10.1016/j.vhri.2013.02.009

OBJECTIVES: This study evaluated the clinical and economic impacts of clinical pharmacy education (CPE) on infection management among patients with chronic kidney disease (CKD) stages 4 and 5 in Haji Adam Malik Hospital, Indonesia.
METHODS: A quasi-experimental economic evaluation comparing CPE impact on 6-month CKD mortality was conducted on the basis of payer perspective. The experimental group (n = 63) received care by health care providers who were given CPE on drug-related problems and dose adjustment. The control group (n = 80) was based on the historical cohort of patients who received care before the CPE. Measure of clinical outcome applied in this study was number of lives saved/100 patients treated. Cost-effectiveness ratios for CKD stages 4 and 5 patients without CPE and with CPE and incremental cost-effectiveness ratios (ICERs) for CKD stages 4 and 5 patients were analyzed.
RESULTS: Lives saved (%) in the treatment of CKD without CPE: CKD stage 4, 78.57; CKD stage 5, 57.58. Lives saved (%) in the treatment of CKD with CPE: CKD stage 4, 88.89; CKD stage 5, 65.45. Cost-effectiveness ratios for stage 4 with and without CPEs were Rp3,348,733.27 and Rp3,519,931.009, respectively. Cost-effectiveness ratios for stage 5 with and without CPEs were Rp7,137,874.93 and Rp7,871,822.27, respectively. ICERs were Rp2,045,341.22 for CKD stage 4 and Rp1,767,585.60 for CKD stage 5.
CONCLUSIONS: Treatment of CKD stages 4 and 5 with CPE was more effective and cost-effective compared with treatment of CKD stages 4 and 5 without CPE. The ICERs indicated that extra costs were required to increase life saved in both stages.
Partially degradable friction-welded pure iron-stainless steel 316L bone pin

Nasution AK, Murni NS, Sing NB, Idris MH, Hermawan H

J Biomed Mater Res B Appl Biomater, 2015 Jan;103(1):31-8.
PMID: 24757071 DOI: 10.1002/jbm.b.33174

This article describes the development of a partially degradable metal bone pin, proposed to minimize the occurrence of bone refracture by avoiding the creation of holes in the bone after pin removal procedure. The pin was made by friction welding and composed of two parts: the degradable part that remains in the bone and the nondegradable part that will be removed as usual. Rods of stainless steel 316L (nondegradable) and pure iron (degradable) were friction welded at the optimum parameters: forging pressure = 33.2 kPa, friction time = 25 s, burn-off length = 15 mm, and heat input = 4.58 J/s. The optimum tensile strength and elongation was registered at 666 MPa and 13%, respectively. A spiral defect formation was identified as the cause for the ductile fracture of the weld joint. A 40-µm wide intermetallic zone was identified along the fusion line having a distinct composition of Cr, Ni, and Mo. The corrosion rate of the pin gradually decreased from the undeformed zone of pure iron to the undeformed zone of stainless steel 316L. All metallurgical zones of the pin showed no toxic effect toward normal human osteoblast cells, confirming the ppb level of released Cr and Ni detected in the cell media were tolerable.
Fulltext Declining Orangutans Population in the Unprotected Forest of Batang Toru

Nasution A, Perwitasari-Farajallah D, Utami-Atmoko SS

Trop Life Sci Res, 2018 Jul;29(2):77-87.
PMID: 30112142 DOI: 10.21315/tlsr2018.29.2.6

Habitat loss and hunting are major threats to the long-term survival of the viable orangutan population in Batang Toru. East Batang Toru Forest Block (EBTFB) is the most threatened area due to low forest cover and high encroachment. Based on a preliminary survey in 2008, Hopong forest which is located in EBTFB, had the highest orangutan density (0.7 ind/km2). However illegal logging and hunting of protected species were occuring in this unprotected forest. Since this location has been gazetted as unprotected forest from the first survey until this study was conducted, it is important to assess orangutans population trends. This study aims to provide an updated density of orangutan in Hopong forest. The study included the location of the original survey but covered a wider overall area. The line transect method was used to record orangutan nests, ficus and trees bearing fruits. A quadrat method was used to record vegetation. The encounter rate of orangutan declined from 0.7 ind/km2 to 0.4 ind/km2 between 2008 and 2015. Forest cover has also changed in the seven years between surveys and this has influenced orangutan and orangutan nest encounter rates in Hopong. Since unprotected forest is at more risk in comparison with protected forest, allocation status of the Hopong forest is critical to reduce the threats it faces.
In vitro and in vivo degradation evaluation of novel iron-bioceramic composites for bone implant applications

Ulum MF, Arafat A, Noviana D, Yusop AH, Nasution AK, Abdul Kadir MR, et al.

Mater Sci Eng C Mater Biol Appl, 2014 Mar 1;36:336-44.
PMID: 24433920 DOI: 10.1016/j.msec.2013.12.022

Biodegradable metals such as magnesium, iron and their alloys have been known as potential materials for temporary medical implants. However, most of the studies on biodegradable metals have been focusing on optimizing their mechanical properties and degradation behavior with no emphasis on improving their bioactivity behavior. We therefore investigated the possibility of improving iron biodegradation rate and bioactivity by incorporating various bioactive bioceramics. The iron-based bioceramic (hydroxyapatite, tricalcium phosphate and biphasic calcium phosphate) composites were prepared by mechanical mixing and sintering process. Degradation studies indicated that the addition of bioceramics lowered the corrosion potential of the composites and slightly increased their corrosion rate compared to that of pure iron. In vitro cytotoxicity results showed an increase of cellular activity when rat smooth muscle cells interacted with the degrading composites compared to pure iron. X-ray radiogram analysis showed a consistent degradation progress with that found in vivo and positive tissue response up to 70 days implantation in sheep animal model. Therefore, the iron-based bioceramic composites have the potential to be used for biodegradable bone implant applications.
Fulltext Development of Mobile App for Breast Examination Awareness Using Health Belief Model: A Qualitative Study

Nasution A, Yusuf A, Lean Keng S, Rasudin NS, P Iskandar YH, Ab Hadi IS

Asian Pac J Cancer Prev, 2021 Oct 01;22(10):3151-3163.
PMID: 34710991 DOI: 10.31557/APJCP.2021.22.10.3151

BACKGROUND: Mobile health technologies are widely being used for delivering health behaviour interventions. However, there is insufficient evidence that they are integrating theory and only a few researchers utilized a qualitative approach in their study.
OBJECTIVES: This paper aims to identify requirements in developing a breast examination awareness mobile app based on the component of the Health Belief Model (HBM) for integration in health promotion strategy.
METHODS: A qualitative approach using semi-structured in-depth interview was utilized in this study. A purposive sampling method was conducted among public women attending hospital services, software and content experts in a tertiary teaching hospital in the East coast of Peninsular Malaysia. These interviews were recorded, transcribed and organized using NVIVO 11. The main themes were identified through thematic analysis of the interview transcripts. Results: A total of 37 participants recruited in this study. The themes that emerged from the analysis are vulnerability, forecasting, reactive, influence, outcome and obstacles. The sub-themes findings supported the HBM's component in terms of the requirement for are an infographic risk factor, video (symptoms, self-examination), info (metastasis, survival, screening, triple assessment, treatment, myth and facts, benefit of early treatment, support groups), features (screening reminder, sharing button, prompt) and mobile app's design.
CONCLUSION: The research findings could provide a guide for future app development from public women, content and software experts. The information will be used to develop a breast examination awareness mobile app integrated with health theories.
Fulltext Breast awareness mobile apps for health education and promotion for breast cancer

Yusuf A, P Iskandar YH, Ab Hadi IS, Nasution A, Lean Keng S

Front Public Health, 2022;10:951641.
PMID: 36324460 DOI: 10.3389/fpubh.2022.951641

BACKGROUND: Lack of knowledge, poor awareness, and attitude are barriers to breast cancer (BC) screening participation. The ubiquitous usage of mobile phones makes it a perfect platform for delivering interventions to increase knowledge and awareness in screening, a strategy for early identification of BC. However, although numerous applications for BC prevention are available on major mobile phone platforms, relatively few have been tested in scientific studies to determine their efficacy.
OBJECTIVE: This study aimed to assess the efficacy of BrAware Apps in increasing the knowledge of BC risk factors, awareness of warning signs and confidence in breast self-examination (BSE) among women in northeast peninsular Malaysia.
METHODS: A quasi-experimental pre and post-test research design were conducted with 41 women participants in Kelantan, Malaysia, before and after using the BrAware apps. Participants were given an online, adapted Breast Cancer Awareness Measure questionnaire. Post-test was 2 months after using the BrAware apps. Comparison using paired T-tests were conducted to evaluate the change in knowledge of risk factors, warning signs awareness and confidence level for BSE.
RESULTS: The mean age of women was 39.71(SD = 8.80). The participants' mean knowledge score of BC warning signs differs before using BrAware (mean 70.62, SD 11.74) and after using the BrAware app (mean 79.83, SD 10.15) at the <0.001 level of significance.
CONCLUSIONS: The BrAware mobile app had a positive effect in increasing the women's knowledge of risk factors of BC, warning signs awareness and confidence level for BSE. It can be concluded that the mobile app may be an adjunct in educating women on BC.
Current insights and future perspectives of flavonoids: A promising antihypertensive approach

Harahap U, Syahputra RA, Ahmed A, Nasution A, Wisely W, Sirait ML, et al.

Phytother Res, 2024 Apr 14.
PMID: 38616386 DOI: 10.1002/ptr.8199

Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically exceeding 140/90 mmHg. Endothelial dysfunction and reduced nitric oxide (NO) bioavailability play crucial roles in hypertension development. L-NG-nitro arginine methyl ester (L-NAME), an analog of L-arginine, inhibits endothelial NO synthase (eNOS) enzymes, leading to decreased NO production and increased BP. Animal models exposed to L-NAME manifest hypertension, making it a useful design for studying the hypertension condition. Natural products have gained interest as alternative approaches for managing hypertension. Flavonoids, abundant in fruits, vegetables, and other plant sources, have potential cardiovascular benefits, including antihypertensive effects. Flavonoids have been extensively studied in cell cultures, animal models, and, to lesser extent, in human trials to evaluate their effectiveness against L-NAME-induced hypertension. This comprehensive review summarizes the antihypertensive activity of specific flavonoids, including quercetin, luteolin, rutin, troxerutin, apigenin, and chrysin, in L-NAME-induced hypertension models. Flavonoids possess antioxidant properties that mitigate oxidative stress, a major contributor to endothelial dysfunction and hypertension. They enhance endothelial function by promoting NO bioavailability, vasodilation, and the preservation of vascular homeostasis. Flavonoids also modulate vasoactive factors involved in BP regulation, such as angiotensin-converting enzyme (ACE) and endothelin-1. Moreover, they exhibit anti-inflammatory effects, attenuating inflammation-mediated hypertension. This review provides compelling evidence for the antihypertensive potential of flavonoids against L-NAME-induced hypertension. Their multifaceted mechanisms of action suggest their ability to target multiple pathways involved in hypertension development. Nonetheless, the reviewed studies contribute to the evidence supporting the useful of flavonoids for hypertension prevention and treatment. In conclusion, flavonoids represent a promising class of natural compounds for combating hypertension. This comprehensive review serves as a valuable resource summarizing the current knowledge on the antihypertensive effects of specific flavonoids, facilitating further investigation and guiding the development of novel therapeutic strategies for hypertension management.