Syed Shahzad Hasan

Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics

OBJECTIVEnThe primary objective of this study was to evaluate the use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Another aim was to identify demographic and socio-economic factors that are associated with CAM use.nnnRESEARCH DESIGN AND METHODSnFace-to-face interviews of conveniently selected patients with chronic diseases were conducted in outpatient clinics of a general hospital. A validated data collection form was used to gather the information regarding pattern, perception, reasons, and perceived effect of CAM on the disease state. The other relevant information including demographics, diagnosis, indication, and treatment were collected from the patients medical records.nnnRESULTSnOut of 321 patients interviewed in this study, 205 patients were using some form of CAM, and thus the utilisation rate was 63.9%. A significant number of patients (35.5%) were using CAM for diabetes mellitus. Thirteen types of CAM were identified in the study with the most common being vitamins supplements (48.2%), herbal medicines (26.4%), ginseng (4.7%) and traditional Chinese medicine (4.0%). The patients with higher education level, higher income, and aged more than 50 years were independently associated with CAM use. Majority of the patients (77.6%) reported that their condition had improved by using CAM.nnnCONCLUSIONnThe present study confirms the high frequency of CAM use among patients with chronic diseases in a Malaysian public hospital. The popularity of CAM indicated the patients preference towards holistic approach to health care.

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.

Residential Aged Care Medication Review to Improve the Quality of Medication Use: A Systematic Review

BACKGROUNDnAging is often associated with various underlying comorbidities that warrant the use of multiple medications. Various interventions, including medication reviews, to optimize pharmacotherapy in older people residing in aged care facilities have been described and evaluated. Previous systematic reviews support the positive impact of various medication-related interventions but are not conclusive because of several factors.nnnOBJECTIVESnThe current study aimed to assess the impact of medication reviews in aged care facilities, with additional focus on the types of medication reviews, using randomized controlled trials (RCTs) and observational studies.nnnMETHODSnA systematic searching of English articles that examined the medication reviews conducted in aged care facilities was performed using the following databases: PubMed, CINAHL, IPA, TRiP, and the Cochrane Library, with the last update in December 2015. Extraction of articles and quality assessment of included articles were performed independently by 2 authors. Data on interventions and outcomes were extracted from the included studies. The SIGN checklist for observational studies and the Cochrane Collaborations tool for assessing risk of bias in RCTs were applied. Outcomes assessed were related to medications, reviews, and adverse events.nnnRESULTSnBecause of the heterogeneity of the measurements, it was deemed inappropriate to conduct a meta-analysis and thus a narrative approach was employed. Twenty-two studies (10 observational studies and 12 controlled trials) were included from 1141 evaluated references. Of the 12 trials, 8 studies reported findings of pharmacist-led medication reviews and 4 reported findings of multidisciplinary team-based reviews. The medication reviews performed in the included trials were prescription reviews (nxa0=xa08) and clinical medication reviews (nxa0=xa04). In the case of the observational studies, the majority of the studies (8/12 studies) reported findings of pharmacist-led medication reviews, and only 2 studies reported findings of multidisciplinary team-based reviews. Similarly, 6 studies employed prescription reviews, whereas 4 studies employed clinical medication reviews. The majority of the recommendations put forward by the pharmacist or a multidisciplinary team were accepted by physicians. The number of prescribed medications, inappropriate medications, and adverse outcomes (eg, number of deaths, frequency of hospitalizations) were reduced in the intervention group.nnnCONCLUSIONnMedication reviews conducted by pharmacists, either working independently or with other health care professionals, appear to improve the quality of medication use in aged care settings. However, robust conclusions cannot be drawn because of significant heterogeneity in measurements and potential risk for biases.

Assessment of attitudes for interprofessional team working and knowledge of health professions competencies for final year health professional students

Inter-professional education (IPE) contributes to the development of an ‘inter-professional, collaborative and practice-ready’ healthcare workforce that is well prepared to respond to local healthcare needs. Little is known about the extent, to which health professional students who are nearing graduation understand the competencies of diverse health professions. The aim of this study was to investigate the perception of final-year undergraduate students’ towards interprofessional team working and their knowledge of the competencies of 6 health professions. This study evaluated the final-year health professional students’ from six (6) health professions programmes namely medical, dental, nursing, pharmacy, dietetics and biomedical sciences programmes. Attitudes towards Health Care Team Scale (ATHCTS) was used to measure students’ attitudes towards teamwork while a checklist was used measure students’ knowledge of 6 health professionals competencies. Construct validity was ascertain and findings from ATHCTS showed mean scores ranges from 48.57 to 54.23 indicating positive attitudes toward working within interprofessional health care teams. While the ACTHS findings were positive, the competencies checklist showed mixed findings in that students correctly identified some competencies and had misconceptions for others. For example, the majority of students regarded physicians as competent in ‘assessment and evaluation’ and ‘medication management’ while less than 50% of participants recognised the importance of assessment of patient’s health-illness as a competency for dieticians. Gaps identified in final year students’ knowledge of the roles and competencies of health professions has an impact on future interprofessional collaborative practice suggesting a need to further improve curriculum design and delivery of IPE.

Access to High Cost Medicines: An Overview

Abstract High-cost medicines (HCMs) have been largely defined based on monetary value because of their potential to increase pharmaceutical spending for either the individual patient or healthcare systems. One of the biggest challenges encountered by many healthcare systems around the globe is to provide equitable access to HCMs while maintaining the sustainability of systems that are already constrained in resources. The global medicine spending is expected to increase with growing use of HCMs for an increasing number of diseases. Many newly developed medicines that offer therapeutic advantages for a range of diseases are reported to be efficacious, but are expensive for healthcare systems and/or patients compared to traditional medicines. Country’s wealth and/or affordability of the healthcare system has a direct relationship with patients’ access to HCMs. The developed markets are better resourced than developing countries and therefore are more likely to meet the demands for access to and use of HCMs. Nevertheless, all countries are facing the challenges of rationing and prioritising access to HCMs. Disproportional access to HCMs, particularly in nations where patient out-of-pocket costs largely support their treatment, might be particularly concerning.

Adherence of safety information on over-the-counter product labels and leaflets to the regulatory guidelines in Malaysia

To evaluate the adherence of medication safety information provided on over‐the‐counter (OTC) product labels and patient information leaflets (PILs) to the Malaysian and international regulatory guidelines.

A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting

Background: There is currently a need for high quality evaluations of new mobile health, telehealth, smart pump and monitoring technologies undertaken in a pharmacy-related setting. We aim to evaluate the use of these monitoring technologies performed in this setting. Methods: A systematic searching of English articles that examined the quality and the design of technologies conducted in pharmacy-related facilities was performed using the following databases: MEDLINE and Cumulative index to Nursing and Allied Health Literature (CINAHL) to identify original studies examining the quality and the design of technologies and published in peer-reviewed journals. Extraction of articles and quality assessment of included articles were performed independently by two authors. Quality scores over 75% are classed as being acceptable using a “relatively conservative” quality benchmark. Scores over 55% are included using a “relatively liberal” cut-off point. Results: Screening resulted in the selection of 40 formal evaluations. A substantial number of studies (32, 80.00%) were performed in the United States, quantitative in approach (33, 82.50%) and retrospective cohort (24, 60.00%) in study design. The most common pharmacy-related settings were: 22 primary care (55.00%); 10 hospital pharmacy (25.00%); 7 community pharmacy (17.50%); one primary care and hospital pharmacy (2.50%). The majority of the evaluations (33, 82.50%) reported clinical outcomes, six (15.00%) measured clinical and economic outcomes, and one (2.50%) economic only. Twelve (30.00%) quantitative studies and no qualitative study met objective criteria for “relatively conservative” quality. Using a lower “relatively liberal” benchmark, 27 quantitative (81.82%) and four qualitative (57.41%) studies met the lower quality criterion. Conclusion: Worldwide, few evaluations of mobile health, telehealth, smart pump and monitoring technologies in pharmacy-related setting have been published.Their quality is often below the standard necessary for inclusion in a systematic review mainly due to inadequate study design.

Academic dishonesty among academics in Malaysia: a comparison between healthcare and non-healthcare academics

BackgroundThis study was carried out to gauge the prevalence of academic dishonesty among academics in Malaysian universities. A direct comparison was made between academics of healthcare and non-healthcare courses to note the difference in the level of academic integrity between the two groups. In addition, the predisposing factors and implications of academic dishonesty, as well as the different measures perceived to be effective at curbing this problem were also investigated.MethodsA cross-sectional study design with mixed qualitative and quantitative approaches was employed and data collection was carried out primarily using self-administered questionnaire.ResultsApproximately half (52.5%, nu2009=u200974) of all respondents (nu2009=u2009141) reported having personally encountered at least one case of academic dishonesty involving their peers. The results also revealed the significantly higher prevalence of various forms of academic misconduct among healthcare academics compared to their non-healthcare counterparts. Although respondents were generally conscious of the negative implications associated with academic dishonesty, more than half of all cases of misconduct were not reported due to the indifferent attitude among academics. Low levels of self-discipline and integrity werexa0found to be the major factors leading to academic misdeeds and respondents opined that university managements should be more proactive in addressing this issue.ConclusionsThe outcome of this study should serve as a clarion call for all relevant stakeholders to start making immediate amends in order to improve the current state of affairs in academia.

Attitudes and barriers towards HIV screening: a qualitative study of people living with HIV/AIDS (PLWHA) in Malaysia

Background: Understanding patients’ perspective towards HIV screening in Malaysia is pivotal to explore challenges faced by these individuals. This would be beneficial for developing local plans to improve the health-seeking behaviours among population at risk of HIV/AIDS. Methods: A qualitative research methodology was adopted to explore HIV/AIDS patients’ views about disease screening. A semi-structured interview guide was used for in-depth patient interviews. All interviews were audio-recorded and were subjected to a standard content analysis framework for data analysis. Results: Most patients were positive about screening and the value of knowing about their status early. However, fear of social stigma, discrimination, lack of support system and lack of public understanding were identified as major concerns affecting their willingness to be screened. They were concerned about mandatory screening being implemented without improvement in support system and public education. Conclusions: Reluctance to seek HIV screening is an important factor contributing to transmission in developing countries. In the Malaysian context, efforts should be made to strengthen screening strategies especially in the most-at-risk populations to monitor the epidemic and target prevention strategies. Practice implications: In a multicultural context, HIV preventive strategies must include disease awareness, including measure to tackle barriers towards screening.