Keivan Ahmadi

Influences on Malaysian Pharmacy Students' Career Preferences

Objectives. To identify and evaluate factors affecting the career preferences of fourth-year bachelor of pharmacy (BPharm) students in Malaysia in the presence of a 4-year period of mandatory government service. Methods. A validated self-administered questionnaire was used in this cross-sectional study to collect data from final-year BPharm students enrolled at 3 government-funded universities and 1 private university in Malaysia. Both descriptive and inferential statistics were used for data analysis. Results. Three hundred fourteen students responded (213 from public universities and 101 from the private university). Approximately 32% of public university students and 37% of private university students ranked their own interest in pharmacy as the reason for undertaking pharmacy degree studies; 40.4% of public and 19.8% of private university respondents stated that they would enter a nonpharmacy-related career upon graduation if given the choice. Public university students ranked hospital pharmacy as their choice of first career setting (4.39, p = 0.001), while private students ranked community pharmacy first (4.1, p = 0.002). On a scale of 1 to 5, salary received the highest mean score (3.9 and 4.0, p = 0.854) as the extrinsic factor most influencing their career choice. Conclusions. Final-year students at Malaysian public universities were most interested in hospital pharmacy practice as their first career step upon graduation, while private university students were most interested in community pharmacy. The top 3 extrinsic factors rated as significant in selecting a career destination were salary, benefits, and geographical location.

Patient-reported adverse drug reactions and drug-drug interactions: a cross-sectional study on Malaysian HIV/AIDS patients

Objective: This study aimed to explore the adverse drug reactions (ADRs) reported by patients and to identify drug-drug interactions (DDIs) among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Subjects and Methods: This cross-sectional study was conducted at the Medication Therapy Adherence Clinic, Hospital Sungai Buloh, an HIV/AIDS referral centre. The patients were randomly selected and were encouraged to describe ADRs caused specifically by any of the prescribed antiretroviral drugs (ARDs). Sociodemographic characteristics were recorded from the patients’ medical records. In addition data on antiretroviral treatment (ART), DDIs and other conventional medication were also documented. Results: A total of 325 randomly selected HIV/AIDS patients with a mean age of 22.94 years participated in the study. The most frequently prescribed ARDs were lamivudine (64.6%), zidovudine (40.6%) and efavirenz (42.5%). Commonly reported ADRs were fatigue (54.8%), allergic reactions (41.5%), weight loss (41.5%), dry mouth (35.1%) and memory loss (35.1%). Female (87.8%), non-complementary and alternative medicine (CAM) users (87.3%) and participants below 50 years old (81.1%) were identified as having a higher prevalence of ADRs compared to males (79.6%), CAM users (78.7%) and participants aged 50 years or more (77.5%). Patient age was found to be significantly associated (p = 0.048) with the ADRs. In addition, a total of 44 cases of DDIs belonging to category D were also found in this study. Conclusions: This study enabled us to identify the most common ADRs and DDIs associated with the use of ART. Safe and effective treatment depends on the healthcare providers’ knowledge of the same.

Publish or perish: a mandate with negative collateral consequences

Today, scientific societies and scholarly communities are more unequivocally determined to fight “peer review fraud” than ever. Predatory publishers publish any article for a fee, but do not adhere to the high standards of typical peer-reviewed scholarly publications. We believe that fraudulent scientific publication processes, despite of all their ramifications, can have positive consequences—namely, bringing researchers and academic institutions together to remove the highly prolific “false data tumor” from the body of knowledge and science. As a robust and holistic solution, we strongly believe that researchers and their employers should be equally educated on how to win the war against organized predatory publishing. We propose the following bilateral intervention that includes both employers and employees of academic institutions.

E-cigarettes: controversies within the controversy

10 years have passed since e-cigarettes were first marketed in the UK. Since then, e-cigarettes have engendered substantial controversy in the realms of public health and respiratory medicine.

A novel nonparametric item response theory approach to measuring socioeconomic position: a comparison using household expenditure data from a Vietnam health survey, 2003

BackgroundMeasures of household socio-economic position (SEP) are widely used in health research. There exist a number of approaches to their measurement, with Principal Components Analysis (PCA) applied to a basket of household assets being one of the most common. PCA, however, carries a number of assumptions about the distribution of the data which may be untenable, and alternative, non-parametric, approaches may be preferred. Mokken scale analysis is a non-parametric, item response theory approach to scale development which appears never to have been applied to household asset data. A Mokken scale can be used to rank order items (measures of wealth) as well as households. Using data on household asset ownership from a national sample of 4,154 consenting households in the World Health Survey from Vietnam, 2003, we construct two measures of household SEP. Seventeen items asking about assets, and utility and infrastructure use were used. Mokken Scaling and PCA were applied to the data. A single item measure of total household expenditure is used as a point of contrast.ResultsAn 11 item scale, out of the 17 items, was identified that conformed to the assumptions of a Mokken Scale. All the items in the scale were identified as strong items (Hi > .5). Two PCA measures of SEP were developed as a point of contrast. One PCA measure was developed using all 17 available asset items, the other used the reduced set of 11 items identified in the Mokken scale analaysis. The Mokken Scale measure of SEP and the 17 item PCA measure had a very high correlation (r = .98), and they both correlated moderately with total household expenditure: r = .59 and r = .57 respectively. In contrast the 11 item PCA measure correlated moderately with the Mokken scale (r = .68), and weakly with the total household expenditure (r = .18).ConclusionThe Mokken scale measure of household SEP performed at least as well as PCA, and outperformed the PCA measure developed with the 11 items used in the Mokken scale. Unlike PCA, Mokken scaling carries no assumptions about the underlying shape of the distribution of the data, and can be used simultaneous to order household SEP and items. The approach, however, has not been tested with data from other countries and remains an interesting, but under researched approach.

Professionalisation and social attitudes: a protocol for measuring changes in HIV/AIDS-related stigma among healthcare students

Introduction HIV/AIDS-related stigma affects the access and utilisation of health services. Although HIV/AIDS-related stigma in the health services has been studied, little work has attended to the relationship between professional development and stigmatising attitudes. Hence, in this study, we will extend earlier research by examining the relationship between the stage of professional development and the kinds of stigmatising attitudes held about people living with HIV/AIDS. Methods and analysis A serial cross-sectional design will be combined with a two-point in time longitudinal design to measure the levels of stigma among healthcare students from each year of undergraduate and graduate courses in Malaysia and Australia. In the absence of suitable measures, we will carry out a sequential mixed methods design to develop such a tool. The questionnaire data will be analysed using mixed effects linear models to manage the repeated measures. Ethics and dissemination We have received ethical approval from the Monash MBBS executive committee as well as the Monash University Human Research Ethics Committee. We will keep the data in a locked filing cabinet in the Monash University (Sunway campus) premises for 5 years, after which the information will be shredded and disposed of in secure bins, and digital recordings will be erased in accordance with Monash Universitys regulations. Only the principal investigator and the researcher will have access to the filing cabinet. We aim to present and publish the results of this study in national and international conferences and peer-reviewed journals, respectively.

A proposal to help achieve equitable treatment of transgender people in the health system.

Admonishing health care providers for not giving equitable care to transgender people is a tempting but least-acceptable option if educators and policy makers in the health care professions are not held equally responsible. If health care providers are not appropriately educated, it is from those who so poorly equipped them that we should seek answers.1 The shortcomings of current health education2 and the urgent need to take remedial actions to address the sensitive and complex issues pertaining to the real-life health care scenarios of transgender people have been well acknowledged.2,3As a robust solution to the health disparities experienced by transgender people, we suggest a two-step targeted approach where interdisciplinary short-term courses (e.g., four courses over a period of four weeks) on the special needs of this marginalized population are delivered to educators and policy makers by appropriate experts in a problem-based learning format. Following that, complementary short (e.g., a three-hour slot) and more specialized courses could be taught. These would focus extensively on the social determinants of the health problems of the marginalized clients. This targeted approach could not only provide more in-depth understanding of the special needs of transgender people but could also trigger movements to influence national and cultural priorities in favor of this group’s right to an equitable health system.

Professionalism in Pharmacy: A Continual Societal and Intellectual Challenge

To the Editor. In early January 2012, a shocking news for the pharmacists and a sad report for the nation struck Malaysia. Two pharmacists were found involved in transferring psychotropic medications out of hospitals and smuggling them into the black market.1 Subsequently, the ministry of health decided to table “The Pharmacy Bill 2012” in the parliament to empower the ministry to take stiffer penalties on pharmaceutical offenders.2

The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes

Abstract Objectives To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes. Methods A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbachs α. Results The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOLs PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01–2.02). Conclusions This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

A Need to Rethink and Mold Consensus Regarding Pharmacy Education in Developing Countries

Health systems struggle to keep up with overwhelming new health challenges.1 Beside financial constraints, public expectations and technological advancement of health service, the other biggest challenge faced by healthcare systems in both the developed and developing world is the high prevalence of non-communicable diseases such as diabetes and hypertension. In the developing world in particular, health systems have responded to these challenges by placing additional demands on health workers1 and by admonishing health care providers for not being appropriately educated. It is unacceptable to blindly blame health professionals while ignoring the shortcomings of the health education system.2 Likewise, pharmacy education in developing countries is also facing challenges such as: Isolation of pharmacy education from the practice of pharmacy.3 Incongruity of pharmacy education with the current needs of the patients and the societies.4 Inharmonious working relationship between different health professions.1 There have been laudable efforts to address some of the shortcomings of the current pharmacy education system in many developing countries.5-10 Notwithstanding, we propose a 6-step “TARGET” approach to overcome the deficiencies of pharmacy education in developing countries. The 6 steps are: Transform our views on “leadership” in pharmacy education. Acknowledge the shortcomings of pharmacy education and audit the current pharmacy syllabi accordingly. Reestablish the professional relevancy of pharmacy education. Gather together the stakeholders in pharmacy education. Elucidate the sets of roles and responsibilities expected from graduate pharmacy students. Tackle new health challenges that arise as responsible members of the healthcare team. In the rest of the letter, we elaborate on each of the 6 steps of our proposed solution. We have to create the “innovator’s DNA” 11 in our pharmacy students by promoting advocacy and by inspiring them to seek leadership roles in the future. Leadership qualities are not inherent but acquired qualities and a high-quality education should include teaching students such qualities. We need innovative and courageous leaders who not only revolutionize pharmacy education and pharmacy practice but also support the next generation of innovators. To be fair, we have to be cognizant of the weaknesses of the current pharmacy education system. These weaknesses should not be interpreted as failure or incompetence. We have to acknowledge that pharmacy education is dynamic and new health needs arise on a daily basis. The patterns of diseases change constantly; therefore, treatment modalities must change as well. We need good documentation systems to monitor and follow up on these changes and this requires a dynamic pharmacy education system that can produce dynamic and well-equipped pharmacists. Unintelligible and static pharmacy curricula cannot mirror the integrated and dynamic demands of health care. The professional relevancy of the current pharmacy education system needs to be reevaluated, restructured, and continuously reexamined. The process might be costly and time consuming, but without a doubt, it will be worth it. The costs incurred from malpractice by ill-equipped pharmacists resulting from an outdated pharmacy education system would be huge and difficult to compensate. Moreover, there is also a need to mobilize the stakeholders in pharmacy education.10 These stakeholders are the ministries of higher learning, health, medical councils, pharmacy councils, nursing associations, clinical pharmacy, industrial pharmacy preceptors, and last but not least, pharmacy students. Pharmacy students are on the receiving end of pharmacy education and it is unfair not to ask their opinions about the pharmacy education system. It is insensitive to discount their concerns about the uncertainties and qualms of the profession and the different modes of its delivery. In addition, we also need to revise student recruitment strategies. An outstanding pre-university track record and high scores in college do not necessarily guarantee success, as the profession of pharmacy needs individuals who are also passionate, proactive, and progressive. Some universities in developing countries are offering pharmacy degrees.12 Each program has its own aims and objectives, and the roles and responsibilities expected of their graduates vary greatly. Furthermore, the ministry of health in many of these countries has defined its own sets of professional duties and responsibilities. We really feel that there is an urgent need to homogenize these diverse sets of roles and responsibilities to facilitate understanding by our pharmacy students and also to reach a consensus on the specific qualities expected of pharmacy graduates. We understand that reaching a consensus might be difficult, but that is not our only aim. We also want to mold the consensus and facilitate procedures that may lead us to achieve an agreement. In the words of the late Martin Luther King, Jr.: “A genuine leader is not a searcher for consensus but a molder of consensus.” With innovative leaders at our disposal, we believe that “consensus” can be molded. Once the consensus is molded, with the help of other members of the healthcare team, we would be able to exceed our current limitations and claim our victory by overcoming the challenges presented by the current health systems.