Syed Imran Ahmed

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.

Clinical Pharmacy and Pharmaceutical Care: A Need to Homogenize the Concepts

To the Editor. The recent article by Benavides et al explored the correlation of faculty members’ publication productivity to student-faculty ratios in colleges of pharmacy. These investigators also evaluated the influence of other factors, such as research funding, public vs. private university status, and supportive faculty members on scholarship. While these areas are important topics of investigation where additional insight would be welcomed, I would like to point out 2 potentially serious methodological errors in the study. These authors attempted to compile publication rates of colleges of pharmacy by searching PubMed. While there is insufficient detail in the article about how these searches were performed, it appears that the authors utilized the affiliation field of the MEDLINE database to search for individual schools and colleges. Unfortunately, the problem with this approach is that the MEDLINE database lists only the address of the corresponding author, not all the authors of the paper. So in a multi-university collaborative paper with, for example, 6 authors, only the corresponding author’s address will appear in the MEDLINE record. This is in contrast to a database such as Science Citation Index (Web of Science online) which captures the address of every author on a particular paper. This error would result in a significantly underestimated publication count for some colleges. The second related error is that many authors do not list ‘‘college of pharmacy’’ or ‘‘school or pharmacy’’ in their addresses. If this were part of the search strategy, it also would contribute to a significant underestimation of the true publication count. As an example, a 2007 calendar year PubMed search for just 3 individual basic science faculty members (KM Giacomini, A Sali, and BK Shoichet), all of whom are listed in the AACP Roster for the 2006-2007 academic year from the University of California at San Francisco (UCSF), yielded 43 nonoverlapping publications. Since bibliometric author searches on any database can be contaminated by homologues (ie, authors with the same name who are in different disciplines or institutions), I was able to validate 33 of these papers by searching the Web site of these faculty members at UCSF. The Benavides study lists only 24 total publications for UCSF for this timeframe. A careful inspection of the MEDLINE records for these 3 faculty members reveals that many list ‘‘Department of Biopharmaceutical Sciences’’ at UCSF in the affiliation field without mentioning school of pharmacy. As a result of these possible errors, this study may have seriously underestimated the publication output of some colleges and schools of pharmacy.

An evaluation of medication appropriateness and frailty among residents of aged care homes in Malaysia: A cross-sectional study

Abstract Aging is significantly associated with the development of comorbid chronic conditions. These conditions indicate the use of multiple medications, and are often warranted by clinical guidelines. The aim of the present study was to evaluate medication appropriateness and frailty among Malaysian aged care home residents with chronic disease. The participants were 202 elderly (≥65 years) individuals, a cross-sectional sample from 17 aged care homes. After ethics approval, each participant was interviewed to collect data on sociodemographics, frailty status (Groningen Frailty Indicator [GFI]), medication appropriateness (Medication Appropriateness Index (MAI), the 2015 Beers’ criteria (Potentially Inappropriate Medication [PIM]), and 2014 STOPP criteria (Potentially Inappropriate Prescribing [PIP]). The findings show that 81% (n = 164) and 42% (n = 85) were taking medications for cardiovascular and central nervous system-related conditions, respectively, and 34% were using medications for diabetes (n = 69). Each participant had a mean of 2.9 ± 1.5 chronic diseases, with an average GFI score of 6.4 ± 3.6. More than three-quarters of the participants (76%) were frail and polypharmacy was a factor in nearly half (48%); 41% and 36% were prescribed at least one PIP and PIM, respectively, whereas the average MAI score was 0.6 (range: 0–6). The number of medications used per participant correlated significantly and positively (0.21, P = .002) with GFI score. These findings reinforce the need for participants of aged care homes to receive periodic medication review aimed at minimizing morbidity associated with inappropriate pharmacotherapy.

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.

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

Patients’ involvement in the care process: time to value nontraditional indicators in HIV care

It is widely accepted that modern medicine has never witnessed any other illness like HIV infection and AIDS, perceptions of which are heavily influenced by moral, religious, social and existential values [1]. Despite commendable global success in preventing and treating HIV infection [2], significant challenges are being faced by the developing world in controlling HIV epidemics due to the lack of and suboptimal use of resources, societal issues and the cultural context, where patients’ belief and understanding play an important role [1]. Therefore, retaining HIV-infected individuals in the continuum of care is vital from both clinical and epidemiological points of view, and requires patient engagement in the care process [3]. One possible way to improve patient engagement is to leverage patient-reported outcomes (PROs) to improve overall patient care [4], thus increasing focus on gaining better understanding of the patient experience, not only from the disease and treatment perspectives, but in terms of the care, services and support they receive. Measuring PROs should be an integral part of a broader approach to patient engagement in the care process, whereby patients’ perspectives can supplement traditional measures such as survival outcomes and process of care [5]. Incorporation of PROs in daily practice by health care providers can allow them not only to receive key information, but to gauge patients’ experiences, including barriers affecting shared decision making [6]. As engagement in the care process is generally greatly welcomed by the patient [7], both quantitative and qualitative approaches should be used in the most effective way possible to understand the extent and reasons behind the issues involved. While various tools and measures have been developed for the purpose, their routine utilization at any point of care has remained fairly low [8]. Thus, it is time to take full advantage of PROs, to ensure effective and holistic patient care, while improving patient satisfaction and empowerment, which will benefit ongoing strategies to end the HIV epidemic by 2030 [9].

Simulation-based instruction for pharmacy practice skill development: A review of the literature

Background: Simulation is attractive for its potential for applying a control over learning environment, content complexity, teacher time, costs and risk. Simulation-based instruction (SBI) is poised to expand in pharmacy practice and education. This systematic review synthesises published, SBI in first-degree pharmacy programmes, especially those pertaining to psychomotor or cognitive skill development. Materials and Methods: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and some education journals were searched for relevant articles published between January 2000 and December 2015. Results: Of 108 articles identified, 12 were included, which were covering four major simulation-based interventions. These simulation-based interventions were diverse, and they covered a range of competencies and outcome measures. Nine studies included medication, and five studies included physical examination/procedure-related competencies as outcome measures. The evidence from nine studies suggested that skills could be improved through interventions involving human patient simulation. Conclusion: Despite improvements in students’ ability to perform, there is a lack of evidence on how this translates to real settings and to patient satisfaction.