Pharmacist-managed DMTAC has been set up in Malaysia government healthcare facilities to assist diabetic patients in improving their medication adherence level and glycaemic control. The aim of this study is to determine the effect of pharmacist involvement in a DMTAC programme on patient glycaemic control in 14 government health clinics in Kuala Lumpur and Putrajaya. This multi-centre retrospective study collected DMTAC patient demographics, medication regimens, glycated haemoglobin (HbA1c) levels, Modified Morisky Medication Adherence Scale (MMMAS) data, and percentages of understanding towards their medications (based on information retrieved and reviewed from their DMTAC booklets). The data were analysed using IBM SPSS Statistics Version 21.0. Fifty six patients were involved in this study. The mean HbA1c reduction (SD) of the pre- and post-intervention groups showed a statistically significant
improvement of 1.0% (1.70) (p<0.001); decreasing from 10.7% (1.51) pre-intervention to 9.7% (1.75) post-intervention. The mean medication understanding score for the postintervention group was 97.6% (7.32), which was significantly higher than the preintervention group score of 92.2% (13.61) (p = 0.005). The mean MMMAS of the postintervention group was 7.4 (1.19), which was significantly higher than the pre-intervention group mean MMMAS of 6.5 (2.33) (p = 0.001). This study demonstrated an improvement in glycaemic control, medication understanding, and adherence level among T2DM patients who were enrolled in a pharmacist-managed DMTAC programme.
Keywords: Diabetes, Diabetes Medication Adherence Therapy Clinic (DMTAC), Endocrine, Pharmacist, HbA1c, Medication adherence, Medication understanding
Medicine is an essential need for many people to treat their illness. Creating awareness among general public regarding medicines use and common illnesses can promote healthy lifestyles among them. The objectives of this study are to determine public knowledge and perception of medicines use and; to explore the pattern of medicines used in the past 3 months. A cross‐sectional survey was carried out among the general public in Pulau Pinang. People who were using medications during the time of the survey or in the last 3 months were invited to participate in the study. Only Malaysians ≥18 years were selected by convenient sampling to participate in the survey. The results of this study showed that most of the respondents were using some sort of medications during the last 3 months. Around 30% did not read the label of the medicines before use. Furthermore, participants had low awareness towards some aspects of medicines use such as the name of generic and brand medicines, overuse of paracetamol or vitamins and their side effects, discontinuation of antibiotics, storing ointments and syrups in refrigerator, and the side effects of medicines registered in Malaysia. Efforts are still needed to increase the awareness of medicines use among the general public. More quantitative studies are needed to understand the factors that may influence public knowledge and perceptions on the use of medicines.
Institutions of higher learning are working hard to provide effective, high quality educational programs. Meanwhile, potential students are also looking at “quality” as a metric to help make their decisions about which college to join. Mechanisms to evaluate the quality of higher education offered in universities are already available. This study aimed to determine students’ attitudes and opinions regarding the pharmacy curriculum at the International Islamic University Malaysia (IIUM). A survey instrument was administered to all final year bachelor of pharmacy (BPharm) students. Forty students (93%) completed and returned the survey. The majority of students (75%) expressed their satisfaction regarding the curriculum in general. Most students (74%) were also satisfied with the courses offered by the department of pharmacy practice. However, students were not satisfied with certain issues such as overlapping of some pharmacy practice courses, and the inclusion of the Malaysian language course in the BPharm curriculum.
Hypertension is a prevalent chronic disease, which is strongly related to the development of cerebrovascular and cardiovascular diseases. The prevalence of hypertension in Malaysia in subjects aged 15 years and above was estimated to be 27.8%. Cost-effectiveness analysis (CEA) compares treatment options with different effectiveness and safety profiles. The utilisation of antihypertensive drugs has raised some concerns about the balance between its costs and benefits. This study was conducted to describe the healthcare costs for hypertensive subjects and to examine the cost-effectiveness of different classes of antihypertensive drugs used in Malaysia. Retrospective and prospective data analysis of a cohort of uncomplicated hypertensive patients was conducted to determine ambulatory health care costs among hypertensive patients groups. The total direct and
indirect costs of controlled and uncontrolled blood pressure (BP) were described. The health care
costs ($) / clinical outcome (AC/E ratio) was calculated. Mean total direct costs per patient per month was higher in uncontrolled blood pressure groups compared to the controlled blood pressure groups. The cost-effectiveness relationship was more favourable for diuretics (1.9), angiotensin converting enzyme inhibitors (ACEIs) (2.0), prazosin (2.4) and beta blockers (2.5), more than the diuretics and beta blockers combination theraphy (3.0), calcium channel blockers (CCBs) (3.4) and other combinations (6.1). Antihypertensive drugs used to treat hypertensive patients were different
in their cost-effectiveness ratios. Such results will allow health care professionals and/or decision
makers to make better decisions on how to select treatment options for hypertensive patients in
Malaysia and how to distribute and allocate scarce health care resources. Pharmacoeconomic
evaluations can help in making difficult choices rationally and allocate scarce resources efficiently.
Betulinic acid (BA) is a pentacyclic triterpene found in several botanical sources that has been shown to cause apoptosis in a number of cell lines. This study was undertaken to determine the in vitro cytotoxic properties of BA towards the human mammary carcinoma cell line MDA-MB-231 and the human promyelocytic leukaemia cell line HL-60 and the mode of the induced cell death. The cytotoxicity and mode of cell death of BA were determined using the MTT assay and DNA fragmentation analysis, respectively. In our study, the compound was found to be cytotoxic to MDA-MB-231 and HL-60 cells with IC50 values of 58 μg/mL and 134 μg/mL, respectively. Cells treated with high concentrations of BA exhibited features characteristic of apoptosis such as blebbing, shrinking and a number of small cytoplasm body masses when viewed under an inverted light microscope after 24h. The incidence of apoptosis in MDA-MB-231 was further confirmed by the DNA fragmentation analysis, with the formation of DNA fragments of oligonucleosomal size (180-200 base pairs), giving a ladder-like pattern on agarose gel electrophoresis. BA was more cytotoxic towards MDA-MB-231 than HL-60 cells, and induced apoptosis in MDA-MB-231 cells.
exhibits extensive first pass metabolism with poor oral bioavailability (27%–50%) limiting its therapeutic efficiency. The present study involved an attempt to enhance its aqueous solubility by formulating as solid dispersions (SDs) using sodium starch glycollate (SSG) as a carrier. The dispersions were formulated by dispersion method and evaluated by phase solubility, drug content, in vitro release and mathematical modelling. Solid state characterisation of samples was carried out by X-ray diffraction (XRD), differential scanning calorimetric (DSC), Fourier transform infrared spectrophotometry (FTIR), near infrared (NIR), Raman analysis and wettability studies. The phase solubility and thermodynamic parameters indicated the spontaneity and solubilisation effect of carrier. The release rate from the dispersions was higher than pure drug and found to increase with an increase in carrier content. The optimised dispersions were selected based on release studies, profiles and dissolution parameters. XRD, DSC, FTIR, NIR and Raman analysis proved the crystallinity reduction, changes in crystal quality and compatibility between drug and carriers. Wettability studies proved the increased wettability in selected dispersions. Based on the findings, possible mechanisms that would have contributed to dissolution enhancement of CLZ were suggested. Such findings could be extrapolated to enhance the aqueous solubility of other poorly water-soluble drugs.
This study aims to examine the vancomycin initial dosing and the resultant trough level in paediatric patients. In this retrospective observational study, all therapeutic drug monitoring (TDM) records of paediatric patients admitted to Sabah Women and Children Hospital (SWACH) from January 2011 to September 2013 were reviewed and 116 patients without renal disease were included in the study. Of the total, 38.8% were neonates, 32.8% were infants and 28.4% were children. The majority of the patients were intensive care patients (69.0%) and the most common clinical indication for vancomycin was sepsis (44.8%). The four initial dosing regimens identified were 40 mg/kg/day (38.8%), 30 mg/kg/day (31.0%), 60 mg/kg/day (25.0%) and 45 mg/kg/day (5.2%). The distribution of initial dosing regimen was significantly different between the three age groups (p40 mg/kg/day (p=0.007). The proportions of those who achieved the target therapeutic range (10–20 mg/L) in the 2 dosing groups were 30.9% and 60.0% respectively. In conclusion, the study showed that the initial dosing of >40 mg/kg/day is more likely to achieve the target therapeutic range (10–20 mg/L) compared to the initial dosing of ≤40 mg/kg/day.
Programmes that increase awareness of childhood obesity are vital to reducing the
number of obese adults and adults with cardiovascular diseases. However, the
effectiveness of these programmes must be evaluated to optimise resources for childhood
obesity awareness programmes. The present study was conducted to assess the
intermediate cost-effectiveness and provide a cost analysis of childhood obesity health
promotion programmes. This quasi-experimental study compared the intermediate
outcomes of the Sahabat Sihat and Be Best programmes over a six-month period. Data
regarding health-related quality of life (EQ-5D and EQ-VAS), the Knowledge, Attitude and
Practice questionnaire, and biomedical data were obtained from booklets prepared by
MySihat for childhood obesity-related health promotion programmes. Data regarding cost
was obtained from the expenditure records of the respective health promotion
programmes. The intergroup and intragroup comparisons between the EQ-5D and
EQ-VAS results, the Knowledge, Attitude, and Practice scores, and the biomedical data
were explored using the Mann-Whitney and Friedman tests. Descriptive statistics were
utilised in the analysis of the cost results. Be Best and Sahabat Sihat were successful in
helping to prevent overweight respondents from becoming obese. The Attitude score was
higher among the Sahabat Sihat cohort, but the Practice score was higher among the Be
Best cohort. Be Best had a lower mean cost per participant and was more cost-effective
than Sahabat Sihat.
An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
Individualising a drug dosage regimen is more appropriate if it is based on pharmacokinetics data derived from local populations. In this study, we estimated valproic acid (VPA) and carbamazepine (CBZ) clearances in the Malaysian population from routinely collected therapeutic drug monitoring (TDM) data. We also evaluated the effects of gender, age, weight and concurrent antiepileptic drug (AED) therapy on VPA and CBZ clearance. Data was collected retrospectively from TDM forms of adult patients. Apparent drug clearance was estimated based on the standard steady state clearance equation. Mann-Whitney and KruskalWallis tests were used to evaluate gender and therapy differences, while Spearman’s Rank correlation was used to determine the associations of age and weight with clearance. One hundred thirty-two samples for VPA and 67 for CBZ were included in the analysis. Patients’ ages ranged from 15 to 72 years old. Mean VPA and CBZ clearances were found to be 0.36 l/kg/d and 1.60 l/kg/d, respectively. VPA clearance correlated positively but poorly with weight. Our results showed significant differences in (i) VPA clearance among male and female patients and (ii) VPA clearance between monotherapy and combination therapy. These findings provide a guide to initiate maintenance doses of VPA and CBZ in our local patients. Awareness of factors influencing drug clearance should help to optimise patients’ dosing regimens.
The objective of this research was to formulate an aerosol concentrate containing haruan (Channa
striatus) water extract that would produce a thin film when sprayed onto a wound and could be used for wound dressing. The aerosol concentrates were formulated with various polymer and plasticiser mixtures and tested in dispersion systems. The polymers evaluated were hydroxypropyl methylcellulose (HPMC), carboxymethylcellulose sodium (CMC Sodium), acacia, tragacanth, chitosan, gelatine and gelatine (bloom 151–160), all at concentrations of 2%. The plasticisers evaluated were polyethylene glycol (PEG) 400 and 4000, glycerine, propylene glycol, and triacetin. Films were prepared from film-forming dispersions by casting techniques. Film-forming dispersions were characterised in terms of pH, density, surface tension, rheological properties, particle size distribution, and tackiness. Based on these evaluations, HPMC was chosen as the best polymer. It produced a film with the expected qualities and was easy to reproduce in the form of dispersions or as thin transparent films. Glycerine was judged as the most appropriate plasticiser because it produced the concentrate having the desired qualities and properties expected from an aerosol concentrate.
Studies were conducted to assess the percutaneous absorption of the triacyglycerols (TAGs), tocols and carotenoids present in crude and refined palm oil. In vitro experiments using upright Franz diffusion cells were employed to investigate the permeability of these compounds across full thickness human skin and into the receptor solution. Cetrimide, a cationic surfactant was chosen to be used as a solubilising agent in the receptor phase with an optimum concentration of 3.0 mg/mL and was able to provide sink conditions throughout the permeation. TAGs, tocols and carotenoids all permeated human skin from crude palm oil (CPO), whereas only TAGs permeated when refined palm oil (RPO) was used. Of the TAGs, oleic acid-containing TAGs was preferentially absorbed despite palmitic acid being the most prevalent fatty acid (FA) in TAGs. Tocols in the form of α-T3 showed the highest permeation followed by γ-T3, α-T and the lowest permeation was observed for δ-T3. Carotenoids (α-carotene and β-carotene) also showed an appreciable amount of permeation from CPO.
Non-communicable diseases are raising much concern in Malaysia due to changing lifestyles which is parallel to the economic development. Intervention program like community health screening (CHS) allows early detection, prevention and reduction of chronic diseases and its risk factors. This study aimed to assess the obesity level, risk factors for chronic diseases and blood cholesterol level among the Malaysian public. A health screening program was conducted on April 2012 at Sungai Pinang township, in the state of Pulau Pinang, Malaysia. A convenient sample of the general public was recruited. Screening tests consisted of measurements of blood pressure, body mass index (BMI), body fat percentage, visceral fat accumulation (VFA) and blood cholesterol. Chi-square analysis was used to determine the difference between prevalence of obesity among subjects with different age groups and gender. Out of 76 recruited subjects, 23.7% had systolic blood pressure of 140 mmHg or greater and 7.9% had diastolic blood pressure of 90 mmHg or greater. Approximately 51% of the subjects were obese (BMI ≥ 27.5 kg/m2). Body fat percentage was high in 63.6% and 63.0% of male and female subjects, respectively. High VFA (≥15) was found in 19.8% of subjects. There were three newly discovered hypercholesterolemia cases (total cholesterol ≥ 5.2 mmol/L). Counselling was given during the health screening program to help the public to take necessary measures to reduce risk factors while preventing complication resulting from these chronic diseases. In conclusion, prevalence of obesity found to be high in the present screened population.
The appropriateness of sampling times and indications for monitoring of serum drug concentrations for the purpose of therapeutic drug monitoring (TDM) were evaluated at three hospitals on the east coast of Malaysia. Appropriateness criteria for indication and sampling were adapted from previously published criteria and with input from local TDM pharmacists. Six drugs were chosen, namely gentamicin, digoxin, carbamazepine, phenobarbital, phenytoin, and valproic acid. A total of 265 TDM requests were evaluated. Appropriateness of the indication for TDM ranged from 77.4% to 82%, while that for sampling ranged from 34.2% to 62.1%. There were no significant differences between the three hospitals in both categories of appropriateness. Among different drug groups, the percentage of appropriate indication was found to be highest with antiepileptic drugs. Antiepileptic drugs, however, had the lowest rate of appropriate sampling. Overall, findings from the three hospitals showed very encouraging results with almost 80% of the requests considered as appropriately indicated. However, the percentage of appropriateness of sampling was lower, and thus may require further investigation.
The International Pharmaceutical Federation (FIP) adopted a set of Good Pharmacy Practice (GPP) guidelines in 1993 and recommended that the regulatory bodies of individual countries should adapt the guidelines in accordance with their resources. The Malaysian Pharmaceutical Society (MPS) introduced its benchmarking guidelines (BMG) in 2003 as a means to raise the professional standards of the community pharmacy practice in Malaysia. Therefore, this study aimed to determine the extent to which community pharmacies have adopted the BMG. A cross-sectional study was conducted using mail questionnaires, which were posted to all community pharmacies in Malaysia. A total of 371 questionnaires (29.2%) were returned. Only 51.0% of the respondents were aware of the BMG. The extent of compliance with the guidelines was 62.6+21.1% (mean + standard deviation), with a median of 65%. The type and ownership of the community pharmacies were significantly associated with compliance with certain aspects of the guidelines. The main problem in complying with the BMG was financial constraint, and this problem was more likely to occur with independent than with chain pharmacies. However, the respondents generally agreed that most aspects of the BMG could be achieved in less than five years. Since the level of awareness among community pharmacists regarding the BMG is low, the MPS should promote or publicise the BMG further. The BMG should be reviewed before being used as part of the criteria for the accreditation of community pharmacies, as proposed by the MPS to further improve the quality and standards of community pharmacies in Malaysia.
The aim of this study was to investigate the acute (one-day treatment) effect of a methanol extract of
Orthosiphon stamineus, Benth on glutathione-S-transferase (GST) activity in streptozotocin (STZ)-induced diabetic young male and female Sprague Dawley (SD) rats. The methanol extract of O. stamineus was administered orally (5, 31.25, 125 and 500 mg/kg) to diabetic rats, and the effect on GST activity was measured by the method of Habig et al. (1974). No lethality and no significant changes in body weight and water intake were observed in the treated group as compared to the control group. A significant increase in the activity of GST was observed in the liver S-9 cytosolic fraction of diabetic male SD rats treated with 125 mg/kg (P < 0.01) and 500 mg/kg (P < 0.01) of the methanol extract O. stamineus. Administration of 500 mg/kg (P < 0.01) of the methanol extract of O. stamineus to diabetic female SD rats increased GST activity when compared to the control group. This study indicates that the methanol extract of O. stamineus could affect the activity of GST in rat liver and the effect seen was dose-dependent.
We attempted to investigate possible hepatoprotective effect of Eurycoma longifolia jack (ELJ) using carbon tetrachloride-induced (CC14) acute hepatotoxicity model in rats. Hepatotoxicity was induced by oral administration of 4.0mg/kg of CCI4 in corn oil (1:1) once to one experimental group of 5 rats and, in three other similar groups, challenged doses (300, 750 and 1500 mg/kg respectively) of ELJ were given one day before and one hour after 4.0 mg/kg CC14 and then once daily for three consecutive days. Three other groups of 5 rats each serving as controls were administered with distilled water, corn oil and ELJ (750mg/kg) only respectively. Rats were sacrificed on day three (corn oil & CC14 treated groups) and on day 4 (Distilled water, ELJ alone and CC14 with graded doses of ELJ treated groups) and samples of blood and liver tissue were taken for biochemical (serum) and histopathological examinations to assess hepatoprotection of ELJ against CC14-induced hepatotoxicity. In the low (300mg/kg) and medium (750 mg/kg) dose ELJ treated groups, CCI4 induced moderate inflammation, fatty acid change and necrosis of hepatocytes while in the high (1500mg/kg) dose ELJ, CC14 induced severe inflammation, fatty acid change and necrosis of hepatocytes. Biochemical measurements of ALT and ALP shows a moderate and insignificant reduction of serum levels in the low dose ELJ group but a more significant reduction in the medium and high dose ELJ groups when compared with the CC14 only group. The increase in serum total bilirubin caused by CC14 was non-significantly reduced by all the doses of ELJ. Animals treated with CC14 alone and in groups treated with both CC14 and graded doses of ELJ had a reduction in body weight, food and water intake but in ELJ (750mg/kg) only treated group, no such reduction in body weight, food and water intake was observed. This observation suggest that ELJ administered alone did not cause any toxic effect to the liver but in combination with CCI4, appeared to synergize the CC14-induced hepatotoxicity which increases as the dose of ELJ is increased. The anorexic, hypodypsic and reduced body weight evident in the CC14 alone and in ELJ plus CC14 treated groups but not in animals treated with ELJ alone, suggests that ELJ alone does not induce anorexia, hypodypsia or loss of weight. In conclusion, the results of our study suggest that ELJ is not hepatotoxic when given alone and appeared to have some degree of protective effects in rats against CC14-induced hepatotoxicity.
Emergence of various global health problems has widened the pharmacist’s job scope. An accessible resource for health and medication information as the pharmacist strengthen the existing public health system. Achievement of optimal patient outcomes involves community and clinical pharmacist safe and effective medication use. However, the public is still unaware of the pharmacist’s role in public and global health. This essay aims to identify pharmacist’s role in overcoming global health problems with a literature review. Pharmacists’ role change from public care provider to public care profession. The roles of pharmacists in health care team as primary care practitioners can be seen in their management of tropical and chronic diseases. With their evaluation skills and extensive knowledge of drugs. Pharmacists can provide the best medical advice to the patients besides promoting selftreatment on minor ailments. Furthermore, they also help in reducing the medical costs and optimising medications for the patients. The faith of the public in pharmacists on vaccination proves that they accept the involvement of pharmacists in healthcare provision. However, the public awareness towards pharmacists’ role should be improved.
Urolithiasis considered as a disease condition that is neglected in terms of research because of its perceived low prevalence and possibly the seemingly good prognosis associated with it. However, in recent years, the prevalence of urolithiasis is increasing in both developed and developing countries and the disease is associated with significant burden and healthcare cost from patients’ caregivers, and society’s perspective. All healthcare providers (including pharmacists) have an important role to play in the management of this disease and it deserves more attention in terms of clinical practice and research. This review aims to provide a comprehensive understanding of patient satisfaction, from the aspect of defining satisfaction of patients, perceptions toward disease management, and a review of literature of satisfaction of patients with kidney stones and its magnitude in healthcare provided. The medical literature has many articles about urolithiasis management options. However, there have been no sufficient published studies discussing patient-reported outcomes of kidney stone management to evaluate their satisfaction, preferences, treatment expectations, and quality of life. Future studies are needed to spot the light on kidney stones patients’ preferences and reported outcomes.
Over the years, the rights of pharmacists as health care professionals have been a controversial topic in the medical field. Pharmacists worldwide have always been independent in being able to practice medicine in their own way and have been given exclusive dispensing rights to distribute drugs and medicines to patients. In Malaysia, however, this is not the case. The overwhelming opinion has been that pharmacists are losing their dispensing rights because doctors are earning more. The current study was carried out in view of recent debates regarding the implementation of a dispensary separation policy in Malaysia. The main objective of this study was to gain an understanding of the views of and challenges experienced by the public in regards to the implementation of this type of policy. The overall results of this study show that dispensing rights are still viewed with mixed feelings. Study subjects reported believing that pharmacists were capable of dispensing medication but that they lack the confidence to make changes within the existing system. When their conditions were not severe, respondents indicated that they preferred the old system where doctors prescribe them with medicine and they subsequently visit the pharmacy. In conclusion, the majority of interview participants were of the opinion that maintaining the current system would benefit them holistically. In this study, input from a total of 929 respondents was gathered via a structured survey conducted throughout Malaysia. The study findings were also supported by data obtained during interviews carried out with 350 informants regarding their views of the implementation of dispensary separation in Malaysia