Ahmed Awaisu

Evaluation of breast cancer awareness among female university students in Malaysia

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia. Objective The objectives of this study were to evaluate the knowledge of breast cancer risk factors, symptoms and methods of screening among female university students and their perception towards the disease treatment outcomes. Methods A cross-sectional survey was conducted from February to March 2008 at Universiti Sains Malaysia. Two hundred participants from 10 randomly selected faculties were interviewed face to face by a trained pharmacist using a validated questionnaire. In addition to their demographic characteristics, participants were required to answer 22 questions concerning knowledge of breast cancer and five questions related to their perception of breast cancer management and treatment outcomes. Data were analyzed using SPSS version 15. Results The mean age of the respondents was 26.7 (SD=1.9) years. The results showed that the vast majority of the female university students had inadequate knowledge of breast cancer. The mean total knowledge score of the students was 60.7%. Indian students had significantly less knowledge of breast cancer compared to their Chinese and Malay counterparts (p<0.05). However, more than two third of the students were aware of breast self examination (BSE) and clinical breast examination (CBE) recommendations. Furthermore, the students had positive perceptions towards the treatment outcomes of breast cancer. Conclusion This study has highlighted the need of a breast cancer awareness campaign, which should also stress the importance of early detection and reporting of breast cancer.

Evaluating community pharmacists ' perceptions and practices on generic medicines: A pilot study from Peninsular Malaysia

The objective of this paper was to study the perception and practices of community pharmacists on generic medicines in relation to dispensing and substitution trends. A cross-sectional survey of randomly selected community pharmacies across West Malaysia was conducted. A total of 40 pharmacies were surveyed in four geographical regions of West Malaysia by using a questionnaire. About 41 per cent of the respondents had 41–60 per cent of their stocks as generics and more than half of the community pharmacists agreed that high profit margin is one of the reasons for their practice of generic substitution. The majority of the pharmacists (62 per cent) did not favour the concept of compulsory generic substitution. When asked about their views on ‘government-initiated mass campaign’ to the public on generic medicines in lieu of ‘more concerted contribution by the pharmacists on educating consumers’, only 73 per cent agreed with this point. In conclusion branded drugs were widely available at community pharmacies and are actively dispensed by pharmacists even for chronic diseases. The practice of generic substitution/dispensing was more driven by consumer demand than it was influenced by pharmacists. The use of generic medicines can be enhanced by improving their quality, instituting proper generic medicine-substituting policies as well as by educating consumers.

Perspectives of heart failure patients in Malaysia towards medications and disease state management: findings from a qualitative study

AimThis study aimed to explore the experiences of readmitted heart failure (HF) patients towards managing their medical problems and to identify factors influencing their adherence to medications.Subject and methodsA qualitative exploratory study was conducted among HF patients who were admitted to Penang General Hospital, Malaysia. A purposive sample of 15 male and 5 female patients of various ethnic groups were interviewed using a semi-structured interview guide. The interviews were audiotaped and transcribed verbatim for thematic content analysis.ResultsThe interviewed patients were generally disturbed by the deterioration in physiological function due to HF. They were aware of the importance of taking HF medications and control of fluid intake but not sodium intake. However, the participants still needed more clarification on ways to reduce sodium intake and improve adherence to lifelong medications and diet. The respondents identified individualized patient self-care, disease, and medication counseling that empower patients to monitor their own body condition to enhance adherence. Barriers identified were limited communication with health care practitioners, lack of correct information about medications and HF, difficulty in remembering, complexity of regimens, and lack of compelling HF symptoms.ConclusionThe present study has identified empowerment of patients in decision making as the main facilitator to improve adherence. These findings suggest that there is a need for doctors and pharmacists to broaden their involvement in exploring and shaping individual patient’s beliefs regarding HF and its management in order to achieve successful treatment outcomes.

The SCIDOTS Project: evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

BackgroundThere is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.MethodsAn integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.ResultsA linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.ConclusionThis study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.

Knowledge and Perception of Breast Cancer among Women of Various Ethnic Groups in the State of Penang: A Cross-Sectional Survey

Objective: The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. Subjects and Methods: A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher (M.A.H.) using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. Results: The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women (p < 0.001). Only 117 (32.3%) and 120 (33.0%) women were aware of the recommended breast self-examination (BSE) and clinical breast examination (CBE) guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. Conclusion: The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer.

Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia

BackgroundThere is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB) and a large proportion of TB patients may be active smokers. In addition, a previous analysis has suggested that a considerable proportion of the global burden of TB may be attributable to smoking. However, there is paucity of information on the prevalence of tobacco smoking among TB patients in Malaysia. Moreover, the tobacco-related knowledge, attitudes, and behaviors of TB patients who are smokers have not been previously explored. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about the tobacco use knowledge and attitudes of those who are smokers among this population.MethodsData were generated on prevalence rates of smoking among newly diagnosed TB patients in the State of Penang from January 2008 to December 2008. The data were obtained based on a review of routinely collated data from the quarterly report on TB case registration. The study setting comprised of five healthcare facilities (TB clinics) located within Penang and Wilayah Persekutuan, Kuala Lumpur health districts in Malaysia, which were involved in a larger project, known as SCIDOTS Project. A 58-item questionnaire was used to assess the tobacco use knowledge, attitudes and behaviors of those TB patients who were smokers.ResultsSmoking status was determinant in 817 of 943 new cases of TB from January to December 2008. Of this, it was estimated that the prevalence rates of current- and ex-smoking among the TB patients were 40.27% (329/817) and 13.95% (114/817), respectively. The prevalence of ever-smoking among patients with TB was estimated to be 54,220 per 100,000 population. Of 120 eligible participants for the SCIDOTS Project, 88 responded to the survey (73.3% response rate) and 80 surveys were analyzed (66.7% usable rate). The mean (± SD) total score of tobacco use knowledge items was 4.23 ± 2.66 (maximum possible score=11). More than half of the participants (51.3%) were moderately dependent to nicotine. A moderately large proportion of the respondents (41.2%) reported that they have ever attempted to quit smoking, while more than half (56.3%) have not. Less than half (47.5%) of the study participants had knowledge about the body system on which cigarette smoking has the greatest negative effect. The majority wrongly believed that smokeless tobacco can increase athletic performance (60%) and that it is a safe and harmless product (46.2%). An overwhelming proportion (>80%) of the patients believed that: smoking is a waste of money, tobacco use is very dangerous to health, and that smokers are more likely to die from heart disease when compared with non-smokers. The use of smokeless tobacco was moderately prevalent among the participants with 28.8% reporting ever snuffed, but the use of cigar and pipe was uncommon.ConclusionSmoking prevalence rate is high among patients with TB in Malaysia. These patients generally had deficiencies in knowledge of tobacco use and its health dangers, but had positive attitudes against tobacco use. Efforts should be geared towards reducing tobacco use among this population due to its negative impact on TB treatment outcomes.

Impact of connecting tuberculosis directly observed therapy short-course with smoking cessation on health-related quality of life

BackgroundWith evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.MethodsThis was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.ResultsWhen compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, p = 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, p = 0.029, η2 = 0.06], time [F (2, 168) = 139.50, p = < 0.001, η2 = 0.62] and group x time interaction [F (2, 168) = 13.89, p = < 0.001, η2 = 0.14].ConclusionsThis study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.

Heparin-induced thrombocytopenia and recent advances in its therapy

Objectives:  To highlight therapeutic controversies, and present a critical review of the most recent evidence on the management of heparin‐induced thrombocytopenia (HIT).

Outcomes of tuberculosis treatment: a retrospective cohort analysis of smoking versus non-smoking patients in Penang, Malaysia

BackgroundThe association between tobacco smoking and tuberculosis (TB) is increasingly coming to light and the literature is laden with the evidence of this association. However, only a few observational studies specifically investigated the association between smoking and TB treatment outcomes.Aim and methodsThe present study aims to determine the prevalence of smoking among TB patients in Penang and to compare the treatment outcomes between smoking and non-smoking TB patients. A retrospective estimate of smoking prevalence among patients with TB and a retrospective cohort study comparing smoking and non-smoking TB patients with regards to treatment outcomes was conducted. The data were extracted from medical records of newly diagnosed TB patients who registered at a chest clinic at a tertiary care hospital in the state of Penang, Malaysia from January 2006 to June 2008.ResultsThe prevalence of ever-smoking among TB patients was 53.4%. Smoking was significantly associated with male gender, alcohol use, and intravenous drug use (IVDU). Ever smokers had increased likelihood of treatment failure (OR 7.48), default (OR 7.17) and were less likely to be cured (OR 0.34). After controlling for the effects of confounders using multivariate logistic regression, ever smokers were still less likely to be cured (aOR 0.31) and more likely to default treatment (aOR 3.24). Dying from TB did not reach statistical significance.ConclusionPrevalence of smoking was high among TB patients in Malaysia. This study further reaffirms that smoking is an independent predictor of poor TB treatment outcomes and prognosis.

Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine-zinc): a case of decompensated liver cirrhosis in Wilson's disease

Objectives:  To report a case of early‐decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilsons disease.