Yelly Oktavia Sari

Effect of Pharmacist Intervention to Self-Care Practices among Diabetes Patients

Our study objective was to evaluate the pharmacist interventions in providing patient home care. A 24-week longitudinal quasi-experimental-pre-test/post-test study design was used to assess the effectiveness of a diabetes education program to enhance self-care practices. Since this was a longitudinal study a 25% attrition rate was included in the calculation of sample size. Hence the sample size for the proposed study was 106 subjects with 53 subjects in each group. All analyses were done using SPSS version 18 ® . The level of significance was set at 0.05. The Research Ethics Committee of hospital and the Malaysian Medical Research and Ethics Committee approved the study. Of the 109 subjects who met the study-entry criteria, 3 subjects declined to participate due to lack of time and interest. There was no significant relationship between the demographic and clinical characteristic of participants who completed the study. During follow-up there was a statistically significant difference in Self Monitoring Blood Glucose (SMBG) practices between the intervention group (M=2.94, SD=2.25) and control group (M=0.47, SD=1.36; t(127.64)=-8.23, p ≤ 0.001) with moderate effect size (eta squared=0.06). Total physical activity was defined as the combination of non-leisure and leisure activities. There was a statistically significant difference in total physical levels between the intervention (M=14.01, SD=6.41) and control groups (13.21, SD=5.22; t(148.04)=-3.15, p=0.002) with no difference in the non-leisure activity (p=0.43). As for the control group, there was no significant difference in SMBG practices from baseline (M=0.70, SD=1.35) to follow-up (M= 0.47, SD=1.36, t(72)=0.97, P=0.34) and no relationship was found between the number of blood glucose tests done with demographic or clinical variables. Improvement of self-care practices that require lifestyle changes such as diet and increased in physical activities are problematic. This could be due to the complexity of these self-care practices that are socially and culturally constructed and often lifetime habits when compared to SMBG.

Perceived Stress Scale Psychometric Validation for Malaysian Diabetic Patients

Aims: The purpose of this study was to provide factorial analytic findings, construct validation and normative data for the Malaysian diabetic patients. Gender difference was also examined with racial response to PSS-10. Study design: Population base cross sectional survey. Place and Duration of Study: Penang between Nov 2009 and March 2010. Methodology: Cluster random sampling technique was employed for the selection participants in the community. A total of 1924 diabetic patients with age ≥ 18 (mean age = 39.51) were approached; 992 of them were female and 932 of them were male. People rated how often they had experienced these feelings in the last week on a five-point Likert scale from 0 = never to 4 = very often. The scale was translated into Malay language independently by two psychological counselors who had at least a master’s degree and bilingual efficiency. The LISREL 8.30 program was used to assenting factor analysis. Chisquare ( χ 2 )/df (degree of freedom) ratio, GFI (goodness of fit index), AGFI (adjusted goodness of fit index) and root mean square error of approximation (RMSEA) were used to evaluate the fit of the model (two-factor). Results: Barlett’s test of sphericity was 1603.417 ( p< 0.001) and Kaiser-Meyer-Olkin measure of the sampling adequacy was 0.83. Varimax rotation was conducted with these two identified factors. Factor A integrated items 1, 2, 3, 6, 9 and 10, labeled as ‘Perceived Avoidance’ while Factor B containing items 4, 5, 7, 8 and labeled as ‘Perceived

Applicability of Pharmaceutical Care in endocrine clinic of Hospital Penang, Malaysia

Abstract Objective: This study aimed to evaluate the impact of pharmaceutical care on pharmacotherapy optimization and health related quality of life among Diabetes patients of endocrine clinic in Hospital Pulau Pinang,

Factors associated with infections in diabetic population

Increase in the prevalence of diabetes worldwide and it becoming an epidemic has resulted in a clinical research shift to the management of diabetes mellitus globally. The study aimed to investigate the socio-demographic differences among diabetes patients with infection incidence. The study was conducted in an urban, governmental hospital in Penang Malaysia. The records of patients, more than and equal to age 18 years, who were admitted with diabetes mellitus between January 1, 2008 and December 31, 2010 were reviewed. Statistical analyses were performed using SPSS version 17®. This study was approved by the hospitals “Clinical Research Committee (CRC)” as well as “Ministry of Health Malaysia (MOH)”. During the time period of January 2008 through December 2010, there were total 2174 diabetes patients admitted; 2174 (100%) patients’ charts were reviewed. Of the total, 1063 (48.9%) were males and the rest, 1111 (51.1%), females. Mean and standard distribution (SD) showed females have less mean age distribution (35.2 ±4.187 years) as compared to males (37.9±5.724 years). A total of 798 (36.7%) had infection exposure before and/or during hospital admission; statistical significance (p<0.001) was found in association of diabetes ketoacidosis (DKA) and infection exposure. Though the rate of hospitalization increased among females, OR showed that males were more likely to get the infection severely as compared to females (1.81 (95%CI 1.1-2.40) p <0.021). Profound ethnic difference is three times more prone to severity rate of infection among Malay diabetic patients as compared to other non-Malays (OR 3.44 (95%CI 1.60-5.68) p<0.001). Further analysis showed that with the age of � 65 years and history of diabetes (mean ± SD: 27.13 ± 2.782) average patient utilizes 135.7 days (average) of antibiotic course. Increased and recurrent use of antibiotic was found among Malays; also Malays predominantly experience clinical manifestations (poor glycaemic control) as compared to other ethnics. Every third patient with diabetes mellitus had infectious exposure.

Bronchopneumoniae with Melioidosis Infection in a Paediatric Patient

This patient was diagnosed with bronchopneumonia with left plural empyema on admission. A list of various tests was done to identify the causal organism which causes the lung infection. However, the results for all the tests were negative. The doctor prescribed several antibiotics which have actions to cover the most common organisms that can cause bronchopneumoniae in children. However, they were uncertain regarding the specific type or organism which causes the infection. On the 7 th May 2013, Melioidosis test was done on this patient and it had shown positive result. Melioidosis is a type of infection caused by Burkholderia pseudomallei. The treatment was then immediately changed to the antibiotics that have actions on Burkholderia pseudomallei. The combination of IV Imipenem 280 mg TDS and IV Augmentin 280 mg TDS were prescribed to this patient. Many drug related problems were detected in this case study. The doctor prescribed several antibiotics to this patient before coming to a conclusion that the combination of IV Imipenem 280 mg TDS and IV Augmentin 280 mg TDS were the most suitable treatment as the culprit of the lung infection in this child was Burkholderia pseudomallei. The patient was prescribed with quite a number of antibiotics. Based on observations and evaluations, it was found that there were many drug related problems found in this case that can lead to many setbacks. Careful evaluations were done in this patient and all the drug related problems in this case were listed. Authors also took into consideration the doctor’s opinion regarding the antibiotic regimens prescribed. Recommendations or solutions to the drug therapy problems were also listed.

Monitoring of Hypocalcaemia & Hyperglycemia predictive consequences of Thyroidectomy.

Background Hyperglycemia and hypocalcaemia have separately been attributed to adverse outcomes in critically ill patients. The study was aim determine whether hyperglycemia and hypocalcaemia together post-operative effect of thyroidectomy and evaluate the gender & age impact on the extend of clinical condition. Methods All the patients underwent thyroidectomy in the duration of 1st Jan 2012 till 30th June, 2013 in HPP and HUSM Kelantan, Malaysia. Serum evaluation has been made on 4 consecutive reading with duration of 6 hours. The predictive trend has been established to identify the hypokalemic and hyperglycemic condition. Ethical approvals & Patients’ consent forms have been made prior to conduct this study. Results The incidence of hyperglycemia [≥ 150 mg/dl(8.3 mmol/L)] and hypocalcaemia (serum calcium < 8.5 mg/dl (2.2 mmol/L)] were 39.4% and 43.9% respectively. Hyperglycemia and hypocalcaemia associated with age and length of stay, significant association has been found among pre-operative diagnosis as well. The interaction of hyperglycemia and hypocalcaemia did not separate effects on mortality. Conclusion As demonstrated, the prevalence of hyperglycemia and hypocalcaemia in post-thyroidectomy patients is considerable high. Also, the linear association pattern has been shown. However, considering the disease severity, the association of hyperglycemia and hypocalcaemia with surgical ward indicators of morbidity could not be verified.