MyMedR

Fulltext Impact of community pharmacy-based educational intervention on patients with hypertension in Western Nepal

Sharma S, Kc B, Alrasheedy AA, Kaundinnyayana A, Khanal A

Australas Med J, 2014;7(7):304-13.

PMID: 25157270 DOI: 10.4066/AMJ.2014.2133

BACKGROUND: There is a paucity of data regarding the feasibility and impact of community pharmacy-based educational interventions on the management of chronic diseases in developing countries.

AIMS: The aim of this study was to establish the feasibility, and to investigate the impact, of community pharmacy-based educational intervention on knowledge, practice, and disease management of patients with hypertension in Western Nepal.

METHOD: A single-cohort pre-/post-intervention study was conducted from August 2012 to April 2013. The participants included in the study were patients diagnosed with hypertension attending a pharmacist-led hypertension clinic. The educational intervention was conducted by pharmacists, was individualised, and consisted of three counselling sessions over a period of six months. The patients' knowledge of hypertension, their practice of lifestyle modification and non-pharmacological approaches concerning hypertension management, and blood pressure were assessed at baseline and again after nine months by using a pre-validated questionnaire.

RESULTS: Fifty patients met the inclusion criteria and were enrolled in the study. The median (IQR) knowledge score changed from 6 (4) to 13 (0) after the intervention (p<0.01) with the median (IQR) practice score changing from 7 (4) to 16 (2) (p<0.01). The mean (SD) systolic BP changed from 150.1 (7.8) to 137.7 (9.9) (p<0.01) and the mean (SD) diastolic BP from 104 (9.5) to 94.5 (7.8) after the intervention (p< 0.01).

CONCLUSION: A simple, educational intervention by community pharmacists had improved patients' disease knowledge, practice, and management of their hypertension. Evidence suggests Nepalese community pharmacists need could play an important role in the management of chronic diseases like hypertension through simple interventions such as providing educational support for patients.

Fulltext Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia

Hassali MA, Alrasheedy AA, Ab Razak BA, Al-Tamimi SK, Saleem F, Ul Haq N, et al.

Australas Med J, 2014;7(1):35-44.

PMID: 24567765 DOI: 10.4066/AMJ.2014.1936

Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations.

Fulltext Reliable epileptic seizure detection using an improved wavelet neural network

Zainuddin Z, Huong LK, Pauline O

Australas Med J, 2013;6(5):308-14.

PMID: 23745153 DOI: 10.4066/AMJ.2013.1640

Electroencephalogram (EEG) signal analysis is indispensable in epilepsy diagnosis as it offers valuable insights for locating the abnormal distortions in the brain wave. However, visual interpretation of the massive amounts of EEG signals is time-consuming, and there is often inconsistent judgment between experts.

Fulltext A survey of mothers' knowledge about childhood diarrhoea and its management among a marginalised community of Morang, Nepal

Mukhtar A, Mohamed Izham MI, Pathiyil RS

Australas Med J, 2011;4(9):474-9.

PMID: 23393537 DOI: 10.4066/AMJ.2011.821

Diarrhoea, a common disease, is one of the major determinants of childhood morbidity and mortality in Nepal.

Fulltext Surgeons' adherence to guidelines for surgical antimicrobial prophylaxis - a review

Ng RS, Chong CP

Australas Med J, 2012;5(10):534-40.

PMID: 23173017 DOI: 10.4066/AMJ.2012.1312

Surgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP), which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons' adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons' adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.

Fulltext Health innovations in patient decision support: Bridging the gaps and challenges

Ng CJ, Lee YK, Lee PY, Abdullah KL

Australas Med J, 2013;6(2):95-9.

PMID: 23483776 DOI: 10.4066/AMJ.2013.1655

Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs' design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.

Fulltext Health innovation for patient safety improvement

Sellappans R, Chua SS, Tajuddin NA, Lai PSM

Australas Med J, 2013;6(1):60-3.

PMID: 23423150 DOI: 10.4066/AMJ.2013.1643

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

Fulltext Health innovation in cardiovascular diseases

Liew SM, Abdullah A, Abdullah N, Chia YC

Australas Med J, 2013;6(1):67-9.

PMID: 23423184 DOI: 10.4066/AMJ.2013.1629

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Despite efforts to tackle CVD, its prevalence continues to escalate in almost every country. The problem requires an exploration of novel ways to uncover solutions. Health innovations that embrace new knowledge and technology possess the potential to revolutionize the management of CVD. Using findings from published studies on CVD, researchers generated innovations in the areas of global risk assessment, home and remote monitoring and bedside testing. The use of pharmacogenetics and methods to support lifestyle changes represent other potential topics for innovations. Gaps in existing knowledge and practice of CVD provide opportunities for the development of new ideas, practices and technology. However, healthcare professionals need to be cognisant of the limitations of health innovations and advocate for safeguarding patients' wellbeing.

Fulltext A comparative drug utilisation study of the treatment of diabetes in Malaysia and Australia

Hasan SS, Clavarino AM, Mamun AA, Kairuz T

Australas Med J, 2015;8(6):179-88.

PMID: 26213581 DOI: 10.4066/AMJ.2015.2330

Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine.

Fulltext Prevalence of hypertension among the elderly Malays living in rural Malaysia

Rashid A, Azizah A

Australas Med J, 2011;4(6):283-90.

PMID: 23386889 DOI: 10.4066/AMJ.2011.660

BACKGROUND: We are living in an ageing world. The prevalence of hypertension which is an established risk factor for cardiovascular disease and stroke increases with age. The aim of the study was to determine the prevalence of hypertension among the elderly Malays living in rural parts of north Malaysia.

METHOD: This cross-sectional study was conducted among the elderly (aged ≥60) Malay residents living in 22 villages in a northwestern state called Kedah in Malaysia from 2007 to 2009. Kedah has one of the highest rates of elderly population in the country. Data was collected by trained research assistants. Besides the baseline demographic information, blood pressure was measured using standardised methods using a manual sphygmomanometer.

RESULTS: The response rate was 97.7%. The prevalence of hypertension among the elderly in these villages was 54.5% (228), 118 (28.2%) were known to be hypertensive and were on medication and an additional 110 (26.3%) respondents were newly diagnosed. Elevated mean systolic (146.17 ± 25.23) and diastolic (89.68 ± 15.60) blood pressure was noted among the known hypertensive. There was an almost fourfold risk (OR 3.64) of having uncontrolled blood pressure among the known hypertensive on treatment. Those with malnutrition were at an almost twofold at risk of being hypertensive (OR 1.73). Binary logistics regression showed occupation (OR 1.65), marital status (OR 2.32) and body mass index (BMI) (OR 1.62) as significant predictor variables.

CONCLUSION: Screening the elderly for hypertension will benefit this group of people by reducing the morbidity and mortality associated with this condition.

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