Marhanis Salihah Omar

P-glycoprotein expression in Helicobacter pylori-positive patients: The influence of MDR1 C3435T polymorphism

OBJECTIVE:  The aim of this study was to determine whether the presence of Helicobacter pylori (H. pylori) infection and multidrug resistance protein 1 (MDR1) C3435T polymorphism had an influence on P‐glycoprotein (P‐gp) expression in the upper gastrointestinal tract.

Predictive factors for contrast-induced acute kidney injury in high-risk patients given N-acetylcysteine prophylaxis

BACKGROUND Contrast–induced acute kidney injury (CI-AKI) is recognized as a common complication of radiographic contrast-enhanced procedures. N-acetylcysteine (NAC) is commonly prescribed, but CI-AKI can still develop despite NAC administration as prophylaxis. OBJECTIVE Identify the predictive factors for development of CI-AKI in patients prescribed NAC. DESIGN Prospective, cross-sectional. SETTING A tertiary hospital in Malaysia. PATIENTS AND METHODS All adult patients who were prescribed NAC for prevention of CI-AKI were identified through an NAC drug usage monitoring card maintained by the inpatient pharmacy. The study was conducted from March to July 2017. MAIN OUTCOME MEASURES Statistically significant predictive factors for development of CI-AKI despite NAC administration. SAMPLE SIZE 152 RESULTS The most commonly recognized risk factors for CI-AKI present in the study population were renal impairment (n=131, 86.2%), anemia (n=107, 70.4%), and diabetes mellitus (n=90, 59.2%). Hydration therapy was initiated in 128 patients (84.2%) prior to the contrast-enhanced procedure. Sixty-one (40.1%) were treated with nephrotoxic medications concomitantly with NAC. Fifteen (9.9%) patients developed AKI. Hypotension (OR: 6.02; 95% CI 1.25–28.97) and use of high contrast volume (OR: 6.56; 95% CI: 1.41–30.64) significantly increased the odds for AKI. Prior hydration therapy (OR: 0.13; 95% CI 0.03–0.59) showed protective effects. CONCLUSION The risk predictors identified for CI-AKI were hypotension, high contrast volume and prior hydration therapy. LIMITATION May not have identified other confounding factors for development of CI-AKI.

A qualitative study exploring issues related to medication management in residential aged care facilities

Background Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). Participants and methods A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Results and discussion Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. Conclusion There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

Current practice and determinants of medication management in long-term care facilities

Background: Medication management is a complex process which involves different phases including prescribing, transcribing, ordering, dispensing, supplying, administering, and storing. This study aimed to assess the medication adherence and its barriers among the residents in long-term care facilities to identify residents who are at risk for medication-related problem and resident`s beliefs toward medication. Methods: A prospective cross-sectional study was conducted in 24 long-term care facilities in Malaysia. The Chi-square test was performed to see any association between the adherence level and medication beliefs. Results: A total number of 185 residents were interviewed and majority of the residents were identified as highly adherent to their medication. There was a significant association found between duration of disease and medication adherence (P = 0.002). With regards to their belief toward medication, most of the residents had weak necessity scores (mean = 16.85, standard deviation [SD] = ±3.41) and strong concern scores (mean = 13.91. SD = ±2.684). There was a significant association between medication beliefs and medication adherence (P = 0.007), and a high number of residents were identified as at high risk for medication-related problems. Conclusion: Residents′ risk for medication-related problems and their overall well-being should be emphasized and related actions should be taken to rectify the problems.