Tahir Mehmood Khan

Medication Errors in the Southeast Asian Countries: A Systematic Review.

Background Medication error (ME) is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region. Methods The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages) that investigated the incidence and the contributing factors of ME in patients of all ages. Results The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional. Discussion The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed.

Rhizoma coptidis: A potential cardiovascular protective agent

Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality in both the developed and developing world. Rhizoma coptidis (RC), known as Huang Lian in China, is the dried rhizome of medicinal plants from the family Ranunculaceae, such as Coptis chinensis Franch, C. deltoidea C.Y. Cheng et Hsiao, and C. teeta Wall which has been used by Chinese medicinal physicians for more than 2000 years. In China, RC is a common component in traditional medicines used to treat CVD associated problems including obesity, diabetes mellitus, hyperlipidemia, hyperglycemia and disorders of lipid metabolism. In recent years, numerous scientific studies have sought to investigate the biological properties of RC to provide scientific evidence for its traditional medical uses. RC has been found to exert significant beneficial effects on major risk factors for CVDs including anti-atherosclerotic effect, lipid-lowering effect, anti-obesity effect and anti-hepatic steatosis effect. It also has myocardioprotective effect as it provides protection from myocardial ischemia-reperfusion injury. These properties have been attributed to the presence of bioactive compounds contained in RC such as berberine, coptisine, palmatine, epiberberine, jatrorrhizine, and magnoflorine; all of which have been demonstrated to have cardioprotective effects on the various parameters contributing to the occurrence of CVD through a variety of pathways. The evidence available in the published literature indicates that RC is a herb with tremendous potential to reduce the risks of CVDs, and this review aims to summarize the cardioprotective properties of RC with reference to the published literature which overall indicates that RC is a herb with remarkable potential to reduce the risks and damage caused by CVDs.

Community pharmacists' knowledge and perceptions about adverse drug reactions and barriers towards their reporting in Eastern region, Alahsa, Saudi Arabia.

Objective: The present study aims to analyze community pharmacists’ current knowledge and perceived barriers to adverse drug reaction (ADR) reporting systems in the Eastern region, Alahsa, Saudi Arabia. Method: A cross-sectional study was planned from 1 June 2012 to 15 July 2012 among the community pharmacies in the Eastern region, Alahsa. A total of 70 community pharmacists were approached using a cluster sampling method. A self-administered, 28-item questionnaire was used to attain the objectives of the study. Data analysis was done using Statistical Package for Social Science version 13. Relative index ranking was used to identify the top five barriers to the ADR reporting process. Results: Response to the survey was 71.43%. In terms of knowledge about ADRs, very few (four, 8.0%) pharmacists were unable to differentiate between the right and wrong definition of ADRs. About 42 (84.0%) pharmacists mentioned that patients often report adverse events. However, 45 (90.0%) were not aware of the ADR reporting system in Saudi Arabia. A deficient professional environment was the main barrier to the ADR reporting process. In addition, unavailability of the reporting forms and poor understanding of the reporting process were common barriers to the reporting process. Conclusion: Most of the community pharmacists were unaware of the ADR reporting system in Saudi Arabia. Logistic issues were the main barriers to the ADR reporting process.

A meta-synthesis on parenting a child with autism

Background The lifelong nature of autism in a child has deep implications on parents as they are faced with a range of challenges and emotional consequences in raising the child. The aim of this meta-synthesis was to explore the perspectives of parents in raising a child with autism in the childhood period to gain an insight of the adaptations and beliefs of parents toward autism, their family and social experiences, as well as their perceptions toward health and educational services. Methods A systematic search of six databases (PubMed, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects [DARE]) was conducted from inception up to September 30, 2014. Full-text English articles of qualitative studies describing parents’ perceptions relating to the care of children younger than 12 years of age and diagnosed with a sole disorder of autism were included. Results A total of 50 eligible articles were appraised and analyzed, identifying four core themes encompassing all thoughts, emotions, and experiences commonly expressed by parents: 1) The Parent, 2) Impact on the Family, 3) Social Impact, and 4) Health and Educational Services. Findings revealed that parents who have a child with autism experienced multiple challenges in different aspects of care, impacting on parents’ stress and adaptation. Conclusion Health care provision should be family centered, addressing and supporting the needs of the whole family and not just the affected child, to ensure the family’s well-being and quality of life in the face of a diagnosis of autism.

Golden Needle Mushroom: A Culinary Medicine with Evidenced-Based Biological Activities and Health Promoting Properties.

Flammulina velutipes (enoki, velvet shank, golden needle mushroom or winter mushroom), one of the main edible mushrooms on the market, has long been recognized for its nutritional value and delicious taste. In recent decades, research has expanded beyond detailing its nutritional composition and delved into the biological activities and potential health benefits of its constituents. Many bioactive constituents from a range of families have been isolated from different parts of the mushroom, including carbohydrates, protein, lipids, glycoproteins, phenols, and sesquiterpenes. These compounds have been demonstrated to exhibit various biological activities, such as antitumour and anticancer activities, anti-atherosclerotic and thrombosis inhibition activity, antihypertensive and cholesterol lowering effects, anti-aging and antioxidant properties, ability to aid with restoring memory and overcoming learning deficits, anti-inflammatory, immunomodulatory, anti-bacterial, ribosome inactivation and melanosis inhibition. This review aims to consolidate the information concerning the phytochemistry and biological activities of various compounds isolated from F. velutipes to demonstrate that this mushroom is not only a great source of nutrients but also possesses tremendous potential in pharmaceutical drug development.

LINGUISTIC VALIDATION OF THE 5D ITCHING SCALE TO ARABIC IN PATIENTS WITH END‐STAGE KIDNEY DISEASE

BACKGROUND Pruritus is one of the commonest skin complaints in end-stage kidney disease. Pruritus can be effectively managed if proper assessment is carried out to categorise its severity. The objective of this study is to test the reliability of an Arabic version of the 5D-Itching scale (5D-IS). METHOD A self- administered Arabic version of the 5D-IS was tested for linguistic validation. Language validity of the tool was carried by using the forward/backward method. Internal consistency was tested using Cronbachs alpha and Spearmans rank. Factor analysis was performed to assess the content adequacy of the study tool. FINDINGS A total of 151 patients completed the survey. The 5D-IS is mainly comprised of five domains that are used to assess the level of itching. The mean ± SD 5-D score obtained in the study group was 12.7 ± 5.3 with scores ranging between 6 and 25. Cronbachs alpha was 0.850 for the five domains of 5 D-IS. The reliability of five domain 5 D-IS indicates the practical applicability of the instrument with inter-correlation of 0.847 (p < 0.05). CONCLUSION The 5D-IS was found to be a reliable tool for assessing itching in Arabic patients with uraemic pruritus. Due to its simplicity, this tool can easily be used by clinical staff to assess the severity of pruritus.

The Effectiveness and Safety of Topical Capsaicin in Postherpetic Neuralgia: A Systematic Review and Meta-analysis.

In particular, neuropathic pain is a major form of chronic pain. This type of pain results from dysfunction or lesions in the central and peripheral nervous system. Capsaicin has been traditionally utilized as a medicine to remedy pain. However, the effectiveness and safety of this practice is still elusive. Therefore, this systematic review aimed to investigate the effect of topical capsaicin as a pain-relieving agent that is frequently used in pain management. In brief, all the double-blinded, randomized placebo- or vehicle-controlled trials that were published in English addressing postherpetic neuralgia were included. Meta-analysis was performed using Revman® version 5.3. Upon application of the inclusion and exclusion criteria, only six trials fulfilled all the criteria and were included in the review for qualitative analysis. The difference in mean percentage change in numeric pain rating scale score ranges from -31 to -4.3. This demonstrated high efficacy of topical capsaicin application and implies that capsaicin could result in pain reduction. Furthermore, meta-analysis was performed on five of the included studies. All the results of studies are in favor of the treatment using capsaicin. The incidence of side effects from using topical capsaicin is consistently higher in all included studies, but the significance of safety data cannot be quantified due to a lack of p-values in the original studies. Nevertheless, topical capsaicin is a promising treatment option for specific patient groups or certain neuropathic pain conditions such as postherpetic neuralgia.

Tuberculous lymphadenitis at Penang General Hospital, Malaysia.

Objective: To evaluate the incidence, treatment and clinical outcomes of tuberculous (TB) lymphadenitis at Penang General Hospital, Malaysia. Materials and Methods: Penang General Hospital is the referral center for all tuberculosis patients in the state of Penang. Patient records were reviewed to identify patients with confirmed diagnosis of TB lymphadenitis between January 2006 and December 2008. Data were analyzed using SPSS version 15. Results: Of 1,548 tuberculosis cases, 109 (7.0%) patients had TB lymphadenitis. The mean age was 36.4 ± 12.87 years and of the 109 patients with TB lymphadenitis, 35 (33.0%), 37 (34.0%) and 36 (33.0%) were observed for 2006, 2007 and 2008, respectively. Ethnically, 45 (41.3%) were Malay followed by 37 Chinese (33.9%). Among risk factors for TB lymphadenitis, HIV and diabetes mellitus were seen in 17 (15.6%) and 11 (10.0%) patients, respectively. Cough and fever were the most frequently reported symptoms. In a majority of cases (n = 90, 82.5%) positive results were obtained for fine-needle aspiration (FNA). Directly observed therapy was given to all patients. Sixty-two (56.9%) patients were successfully treated, and 5 (4.6%) patients died during the treatment. Conclusion: There was no increase in the incidence of TB lymphadenitis over the 3-year study period. The incidence was slightly higher in male than female gender and in Malay (ethnic group). Diabetes mellitus and HIV were the most commonly reported risk factors. FNA is the most reliable diagnostic test.

A Perspective for Clinical Pharmacy Curriculum Development and Validation in Asian Developing Nations

This perspective is a reflection of the Personal teaching experience of the authors. The aim of this perspective is to identify the weaknesses in the pharmacy curriculum development in Asian developing nations and to propose a methodological approach for curriculum validation. It has been seen that improper selection of the course contents were the common limitations found in the pharmacy curriculum in developing nations. Furthermore, lack of facilities and improper student evaluation system were the other flaws that are acting as a main challenge to pharmacy education in developing nations. A systemic way for the curriculum designing and validation can be a solution to manage the observed deficiencies. Keeping in view this motivation a set of task are defined in the form of Pharmacy Curriculum Development and Validation Model (PCDVM) that can be a guideline for the pharmacy educators for the evaluation and validation of the curriculum. Partial or full implementation of this model will enable the pharmacy institutions to deliver quality knowledge to pharmacy students which will further contribute to quality health care system in developing countries.

Patient-physician Communication Barrier: A Pilot Study Evaluating Patient Experiences

This study aims to identify the patient-physician communication barriers in the primary healthcare setting in Pulau Penang, Malaysia. A cross-sectional study was designed to attain the objectives of the study. A self-developed 17-item study tool was used to explore respondent′s perception about the barriers they have faced while communicating with physician. The reliability scale was applied and internal consistency of the study tool was estimated on the basis of Cronbach′s alpha (α = 0.58). The data analysis was conducted using statistical package for social sciences students SPSS 13® . Chi Square test was used to test the difference between proportions. A total of n = 69 patients responded to this survey. A higher participation was seen by the male respondents, 39 (56.5%). About 52 (76.5%) of the respondents were satisfied with the information provided by the physician. In an effort to identify the patient-physician barriers, a poor understanding among the patients and physician was revealed. 16 (23.5%) respondents disclosed lack of satisfaction from the information provided to them. Overall, it is seen that lack of physician-patient understanding was the main reason that result hindrance in the affective communication. Moreover, there is a possibility that a low level of health literacy among the patients and inability of the physician to affectively listen to patients may be the other factors that result in a deficient communication.