OBJECTIVE: This Cochrane Review aimed to determine the effects of alternating pressure (active) air beds, overlays or mattresses compared with any support surface in preventing pressure ulcers.
METHODS: The population addressed was people at risk of and with existing pressure ulcers. Studies comparing alternating pressure (active) air surfaces with any beds, overlays or mattresses were included. The outcomes studied were pressure ulcer incidence, patient support-surface-associated comfort, adverse events, health-related quality of life and cost-effectiveness.
RESULTS: There were 32 studies with a total of 9058 participants. There is low certainty evidence that alternating pressure (active) air surfaces compared with foam surfaces may reduce the incidence of pressure ulcers. It is uncertain whether there is a difference in the proportion of people developing new pressure ulcers between alternating pressure (active) air surfaces and reactive water-filled, fibre, air, gel or standard hospital surfaces.
CONCLUSION: The use of alternating pressure (active) air surfaces may reduce the incidence of pressure ulcers compared to foam surfaces. However, it is uncertain if it is superior to reactive air surfaces, water surfaces and fiber surfaces in preventing pressure ulcers.
METHODOLOGY: A systematic literature search was conducted on PubMed, Cochrane library, World Health Organization database-Index Medicus for South-East Asia Region (WHO-IMSEAR), and Google Scholar databases. The search period was from 1st January 1990 until 12th May 2022. The prevalence of HAIs and subgroups were calculated using MetaXL software.
RESULTS: The database search retrieved 3879 non-duplicate articles. After applying exclusion criteria, 31 articles with a total number of 47666 subjects were included and a total of 7658 cases of HAIs were recorded. The overall prevalence of HAIs in Southeast Asia was 21.6 % (95% CI: 15.5 - 29.1%) with heterogeneity statistics of I2 = 100%. Indonesia had the highest prevalence rate of 30.4% whereas Singapore had the lowest prevalence rate at 8.4%.
CONCLUSIONS: This study revealed that the overall prevalence of HAIs was relatively high and the prevalence rate of each country was associated with socioeconomic status. Measures should be taken to examine and control the rates of HAIs in countries with high HAI prevalence.
OBJECTIVES: Our study aimed to determine Malaysian hospital pharmacists' perspectives on biosimilars and to identify factors influencing the successful promotion of biosimilars to prescribers.
METHODS: This was a cross-sectional, web-based survey of hospital pharmacists across Malaysia. Multivariate logistic regression analysis was used to identify factors associated with pharmacists successfully promoting biosimilar use.
RESULTS: Of the 913 responses, over 60% of pharmacists believed that patients may safely be switched from the originator product to a biosimilar and would have the same clinical outcome. Many lacked training in biosimilars (62.8%); yet most (80.6%) perceived pharmacists to play a critical role in promoting biosimilar prescribing. Multivariate logistic regression analysis showed that the strongest factor associated with pharmacists' successful promotion of biosimilars to prescribers was having confidence (odds ratio [OR], 3.33; 95% confidence interval [CI] 2.10-5.26). Respondents who had prior experience handling biosimilars were more likely to be successful in promoting biosimilar use than those without (OR, 1.76; 95% CI 1.16-2.66). The pharmacists' top perceived barrier to promote biosimilars in clinical practice was efficacy concerns.
CONCLUSION: Although Malaysian pharmacists are in favour of biosimilars, they lack training to promote biosimilar use. Among the factors associated with successful promotion of biosimilars to prescribers are pharmacist confidence, their previous experience handling biosimilars, and prior biosimilar training.
MATERIALS AND METHODS: Data were collected through medical records and interview sessions with patients on current pharmacotherapy for hypertension management at baseline and 2-3 months later. Results are expressed as mean ± SD for continuous data and as frequencies and percentages for categorical data.
RESULTS: Among 182 recruited patients, 89 (49%) achieved BP control by the end of the study. Majority (62/89) patients were on single-pill (monotherapy or SPC) antihypertensives. Majority (63/89) required more than two antihypertensives to achieve BP control.
CONCLUSION: Both SPC and free drug combination antihypertensives reduced BPs, but physicians preferred SPC to improve BP control and increase treatment compliance.
METHOD: Electronic literature search was conducted on eight databases using keywords and MeSH guidelines. Using the PRISMA protocol, studies published from 2003 to 2022 were retrieved and analyzed.
RESULT: Of the 1481 articles identified, 9 met the inclusion criteria. All the included studies were conducted across 10 of the 36 states in Nigeria, with every geo-political zone in Nigeria represented by at least two studies. The overarching themes identified were attitude and beliefs (n = 7), knowledge of HIV/AIDS (n = 3), quality of care (n = 4), education and in-service training (n = 4), and health facility policies and procedures (n = 3). Factors associated with HIV-related stigma among healthcare workers varied by gender, healthcare settings, specialties of health workers, and the presence of institutional stigma reinforcements. Healthcare workers without recent in-service training on HIV/AIDS and those who work in hospitals without anti-HIV/AIDS stigma policies exhibited more HIV-related stigmatizing attitudes.
CONCLUSION: Continuous in-service training of healthcare workers and the development of comprehensive stigma reduction interventions that will be reinforced with anti-HIV stigma policies in clinical settings may facilitate the attainment of national HIV prevention goals.
METHODS: This multi-database comparative cross-sectional study examined COVID-19 in-patient deaths (IPD) and COVID-19 BID (n = 244 in each group) in Selangor, Malaysia. BID cases, IPD cases, and their sociodemographic, clinical, and health behaviour factors were identified from the COVID-19 mortality investigation reports submitted to the Selangor State Health Department between 14 February 2022 and 31 March 2023. Data linkage was used to connect three open-source databases-GitHub-MOH, Socioeconomic Data and Applications Center, and OpenStreetMap-and identify health infrastructure and geospatial factors. The groups were compared using chi-square tests, independent t-tests, and logistic regression analyses to identify factors associated with COVID-19 BID.
RESULTS: The COVID-19 IPD and BID cases were comparable. After adjusting for confounders, non-Malaysian nationality (AOR: 3.765, 95% CI: 1.163, 12.190), obesity (AOR: 5.272, 95% CI: 1.131, 24.567), not seeking treatment while unwell (AOR: 5.385, 95% CI: 3.157, 9.186), and a higher percentage of COVID-19-dedicated beds occupied on the date of death (AOR: 1.165, 95% CI: 1.078, 1.259) were associated with increased odds of COVID-19 BID. On the other hand, being married (AOR: 0.396, 95% CI: 0.158, 0.997) and the interaction between the percentage of COVID-19-dedicated beds occupied and the percentage of ventilators in use (AOR: 0.996, 95% CI: 0.994, 0.999) emerged as protective factors.
CONCLUSION: These findings indicated that certain groups have higher odds of COVID-19 BID and thus, require closer monitoring. Considering that COVID-19 BID is influenced by various elements beyond clinical factors, intensifying public health initiatives and multi-organisational collaboration is necessary to address this issue.
METHODS: A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings.
RESULTS: Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 - 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation.
CONCLUSIONS: In addition to the global effort to explore sustainable measures to improve patients' emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.