Emergence of various global health problems has widened the pharmacist’s job scope. An accessible resource for health and medication information as the pharmacist strengthen the existing public health system. Achievement of optimal patient outcomes involves community and clinical pharmacist safe and effective medication use. However, the public is still unaware of the pharmacist’s role in public and global health. This essay aims to identify pharmacist’s role in overcoming global health problems with a literature review. Pharmacists’ role change from public care provider to public care profession. The roles of pharmacists in health care team as primary care practitioners can be seen in their management of tropical and chronic diseases. With their evaluation skills and extensive knowledge of drugs. Pharmacists can provide the best medical advice to the patients besides promoting selftreatment on minor ailments. Furthermore, they also help in reducing the medical costs and optimising medications for the patients. The faith of the public in pharmacists on vaccination proves that they accept the involvement of pharmacists in healthcare provision. However, the public awareness towards pharmacists’ role should be improved.
Urolithiasis considered as a disease condition that is neglected in terms of research because of its perceived low prevalence and possibly the seemingly good prognosis associated with it. However, in recent years, the prevalence of urolithiasis is increasing in both developed and developing countries and the disease is associated with significant burden and healthcare cost from patients’ caregivers, and society’s perspective. All healthcare providers (including pharmacists) have an important role to play in the management of this disease and it deserves more attention in terms of clinical practice and research. This review aims to provide a comprehensive understanding of patient satisfaction, from the aspect of defining satisfaction of patients, perceptions toward disease management, and a review of literature of satisfaction of patients with kidney stones and its magnitude in healthcare provided. The medical literature has many articles about urolithiasis management options. However, there have been no sufficient published studies discussing patient-reported outcomes of kidney stone management to evaluate their satisfaction, preferences, treatment expectations, and quality of life. Future studies are needed to spot the light on kidney stones patients’ preferences and reported outcomes.
Over the years, the rights of pharmacists as health care professionals have been a controversial topic in the medical field. Pharmacists worldwide have always been independent in being able to practice medicine in their own way and have been given exclusive dispensing rights to distribute drugs and medicines to patients. In Malaysia, however, this is not the case. The overwhelming opinion has been that pharmacists are losing their dispensing rights because doctors are earning more. The current study was carried out in view of recent debates regarding the implementation of a dispensary separation policy in Malaysia. The main objective of this study was to gain an understanding of the views of and challenges experienced by the public in regards to the implementation of this type of policy. The overall results of this study show that dispensing rights are still viewed with mixed feelings. Study subjects reported believing that pharmacists were capable of dispensing medication but that they lack the confidence to make changes within the existing system. When their conditions were not severe, respondents indicated that they preferred the old system where doctors prescribe them with medicine and they subsequently visit the pharmacy. In conclusion, the majority of interview participants were of the opinion that maintaining the current system would benefit them holistically. In this study, input from a total of 929 respondents was gathered via a structured survey conducted throughout Malaysia. The study findings were also supported by data obtained during interviews carried out with 350 informants regarding their views of the implementation of dispensary separation in Malaysia
Although therapeutic drug monitoring (TDM) has been used in practice, conflicting data on its usefulness in the management of epilepsy have been reported. These results range from identifying no significant differences in patients’ clinical outcomes to determining TDM to be a cost-effective service. Thus, this study was conducted to evaluate the effectiveness of our pharmacist-managed TDM service in helping patients with epilepsy (PWE) to achieve seizure control. This was a retrospective observational study conducted in the TDM Unit of Hospital Keningau, Sabah. Pharmacist-prepared reports issued for 30 subjects with uncontrolled seizures in 2014 were analysed to determine the effectiveness of their recommendations. Effectiveness was measured based on the number of patients who achieved ≥ 50% reduction in seizure frequency and the number of patients with a threemonth seizure-free period. Overall, 80% of the pharmacists’ TDM recommendations were accepted by prescribers. Based on the data collected, 17 (56.67%) subjects had their seizure frequency decreased at least by half, while 11 (36.67%) subjects achieved total remission. However, there was no significant association between acceptance of recommendations and seizure control; although acceptance of pharmacist recommendations was associated with 1.4 times greater odds of achieving seizure control among PWE, this difference was not statistically significant. In conclusion, a pharmacist-managed TDM service was associated with an improvement in seizure control of more than 50% among PWE with unsatisfactory seizure control.
Pharmacists play an important role in healthcare delivery. Over the years, their role has shifted from product-oriented to patient-oriented. This study aimed to assess the perceptions of the public towards the role of pharmacists and the willingness of the public to pay for pharmacist-provided dispensing services in Sabah. This was a questionnairebased, cross-sectional study conducted from September 2014 to June 2015 in three major cities in Sabah, namely, Kota Kinabalu, Sandakan and Tawau. The respondents were conveniently selected and interviewed based on a questionnaire to assess their perceptions of the role of pharmacists. A contingent valuation interview was then conducted to assess the respondents’ willingness to pay. A total of 647 respondents were interviewed. Of the respondents, 61.4% agreed that pharmacists knew more about their medications and side effects and how to use the medications than their doctors. However, more than half of the respondents (54.4%) perceived that the pharmacists’ role was only to supply medications and 66.6% of the respondents perceived that the pharmacist’s role was to follow doctors’ directions. Of the respondents, 89.0% appreciated and adhered to the counselling points provided by their pharmacists; 85.0% of the respondents hoped that pharmacists could play a greater role in healthcare in the future. Forty percent of the respondents agreed that community pharmacists were simply business people who sold products in their pharmacies. Finally, 55.3% of the respondents were willing to pay for pharmacist-provided dispensing services. The median (interquartile ranges [IQR]) amount that they were willing to pay was RM5.00 (IQR RM5.00). Respondents in this study showed variations in their views of the pharmacy profession. Nevertheless, more than half of the respondents valued pharmacist-provided dispensing services and were willing to pay RM5.00 for the services. To improve pharmacy practice, efforts should be undertaken to address the respondents’ misunderstandings about the pharmacy profession and to promote the roles of pharmacists to the general public.
Shared-decision making (SDM), occasionally called “participatory governance” is the approach in healthcare to ensure that patients have the right to participate effectively in the decision-making (DM) process. The aim of this research was to discuss the external aspect of SDM and put forward applicable solutions to ensure SDM at both patient and physician levels. A standardised validated nine-item SDM questionnaire (patient version SDM-Q-9) was employed. SPSS version 25 was used to perform data analysis. Multiple tests such as Mann-Whitney U and Jonckheere-Terpstra were used. Kendall’s Tau coefficient was used for interpretation of the significant relationship among all items of SDM-Q-9 and education. A total of 465 chronically ill patients took part, where majority (63.4%) of patients was above the age of 47. The cohort was dominated by females (67.5%) with 92% of the sample was married. Majority (86.9%) of the patient reported not involved in any decision. During analysis, considerable association was reported between gender and all items of SDM-Q-9, where more men were involved in SDM when compared with women. Our findings did produce significant association between education and SDM-Q-9, which reveals that increase in education can improve the SDM. SDM should not be limited to chronic or emergency in practice. Specific and tailored shared medical DM programmes must be developed for low literacy population implementation. SDM is to be supported at policy and operation levels.
Phenytoin follows Michaelis-Menten, a non-linear pharmacokinetics that occurs when drug molecules saturates the enzymes ability to metabolise the drug. When this occurs, steady state phenytoin serum concentration increases in a disproportionate manner after a dosage increase. General population data are usually used for the phenytoin dose calculation. However, many studies show that population pharmacokinetic parameters of phenytoin have high variations. Thus, use of specific local pharmacokinetic parameters for each population group in estimating individualised phenytoin dose can reduce phenytoin toxicity cases. This prospective, observational study was conducted to estimate a local Vmax and Km of phenytoin for adult epileptic patients in neurological ward and clinic at Hospital Pulau Pinang, Malaysia. All therapeutic drug monitoring of oral capsule phenytoin were studied in a three-month data collection period. Out of the 17 subjects in our study, there are 13 male subjects (76.47%) and 4 female subjects (23.53%). A total 11 Malay subjects (64.71%), 4 Chinese subjects (23.53%) and 2 Indian subjects (11.76%) were included. Median Vmax and Km were found to be 8.25 mg/kg/day and 3.80 mg/l. Male subjects have a higher Vmax (8.30 mg/kg/day) but a lower Km (3.3 mg/l). Chinese population has the highest Vmax (8.80 mg/kg/day). For Km, Indian population is the highest, with a value of 5.5 mg/l. From our study, gender does not correlate with Vmax and Km of phenytoin (p-value > 0.05). Ethnicity was also found to have no association with Vmax and Km (p-value > 0.05). Local Vmax (8.25 mg/kg/day) is higher and Km (3.8 mg/l) is lower when compared with standard Vmax (7 mg/kg/day) and Km (4 mg/l) obtained from Caucasian population.
Comfort and acceptance by healthcare professionals are crucial for effective operation of clinical pharmacy services. To date, there is no published report on the perceptions towards clinical pharmacy services from Tawau, Sabah or anywhere else in Malaysia. The objective of this study is to evaluate the comfort, perceptions and expectations of healthcare professionals towards the clinical pharmacy services in Tawau Hospital. This crosssectional, questionnaire-based study was carried out in 10 wards of Tawau Hospital with clinical pharmacy services, from June to July 2014. Validated questionnaires with consent were anonymously distributed to doctors and nurses. The self-administered questionnaires consisted of four sections: demographic, comfort level, expectations, and experiences dealing with clinical pharmacists. A 4-point Likert scale, where 1 = strongly disagree, while 4 = strongly agree, was used to indicate the level of agreement. Of 292 questionnaires administered, 269 were completed, giving a response rate of 92.1%. Compared to nurses, higher percentage of doctors were less comfortable with clinical pharmacists providing drugrelated education, suggesting the use of drugs to prescribers, designing pharmacotherapy regimes, and monitoring safety and outcomes of the designed regimens. The participants have great expectations, perceptions and experiences with clinical pharmacists of Tawau Hospital. Majority of the healthcare professionals who have direct contact with clinical pharmacists in their work were generally receptive and have high expectations towards patient-oriented clinical pharmacy services.
Pharmacist-managed DMTAC has been set up in Malaysia government healthcare facilities to assist diabetic patients in improving their medication adherence level and glycaemic control. The aim of this study is to determine the effect of pharmacist involvement in a DMTAC programme on patient glycaemic control in 14 government health clinics in Kuala Lumpur and Putrajaya. This multi-centre retrospective study collected DMTAC patient demographics, medication regimens, glycated haemoglobin (HbA1c) levels, Modified Morisky Medication Adherence Scale (MMMAS) data, and percentages of understanding towards their medications (based on information retrieved and reviewed from their DMTAC booklets). The data were analysed using IBM SPSS Statistics Version 21.0. Fifty six patients were involved in this study. The mean HbA1c reduction (SD) of the pre- and post-intervention groups showed a statistically significant
improvement of 1.0% (1.70) (p<0.001); decreasing from 10.7% (1.51) pre-intervention to 9.7% (1.75) post-intervention. The mean medication understanding score for the postintervention group was 97.6% (7.32), which was significantly higher than the preintervention group score of 92.2% (13.61) (p = 0.005). The mean MMMAS of the postintervention group was 7.4 (1.19), which was significantly higher than the pre-intervention group mean MMMAS of 6.5 (2.33) (p = 0.001). This study demonstrated an improvement in glycaemic control, medication understanding, and adherence level among T2DM patients who were enrolled in a pharmacist-managed DMTAC programme.
Keywords: Diabetes, Diabetes Medication Adherence Therapy Clinic (DMTAC), Endocrine, Pharmacist, HbA1c, Medication adherence, Medication understanding
Medicine is an essential need for many people to treat their illness. Creating awareness among general public regarding medicines use and common illnesses can promote healthy lifestyles among them. The objectives of this study are to determine public knowledge and perception of medicines use and; to explore the pattern of medicines used in the past 3 months. A cross‐sectional survey was carried out among the general public in Pulau Pinang. People who were using medications during the time of the survey or in the last 3 months were invited to participate in the study. Only Malaysians ≥18 years were selected by convenient sampling to participate in the survey. The results of this study showed that most of the respondents were using some sort of medications during the last 3 months. Around 30% did not read the label of the medicines before use. Furthermore, participants had low awareness towards some aspects of medicines use such as the name of generic and brand medicines, overuse of paracetamol or vitamins and their side effects, discontinuation of antibiotics, storing ointments and syrups in refrigerator, and the side effects of medicines registered in Malaysia. Efforts are still needed to increase the awareness of medicines use among the general public. More quantitative studies are needed to understand the factors that may influence public knowledge and perceptions on the use of medicines.
Institutions of higher learning are working hard to provide effective, high quality educational programs. Meanwhile, potential students are also looking at “quality” as a metric to help make their decisions about which college to join. Mechanisms to evaluate the quality of higher education offered in universities are already available. This study aimed to determine students’ attitudes and opinions regarding the pharmacy curriculum at the International Islamic University Malaysia (IIUM). A survey instrument was administered to all final year bachelor of pharmacy (BPharm) students. Forty students (93%) completed and returned the survey. The majority of students (75%) expressed their satisfaction regarding the curriculum in general. Most students (74%) were also satisfied with the courses offered by the department of pharmacy practice. However, students were not satisfied with certain issues such as overlapping of some pharmacy practice courses, and the inclusion of the Malaysian language course in the BPharm curriculum.
Hypertension is a prevalent chronic disease, which is strongly related to the development of cerebrovascular and cardiovascular diseases. The prevalence of hypertension in Malaysia in subjects aged 15 years and above was estimated to be 27.8%. Cost-effectiveness analysis (CEA) compares treatment options with different effectiveness and safety profiles. The utilisation of antihypertensive drugs has raised some concerns about the balance between its costs and benefits. This study was conducted to describe the healthcare costs for hypertensive subjects and to examine the cost-effectiveness of different classes of antihypertensive drugs used in Malaysia. Retrospective and prospective data analysis of a cohort of uncomplicated hypertensive patients was conducted to determine ambulatory health care costs among hypertensive patients groups. The total direct and
indirect costs of controlled and uncontrolled blood pressure (BP) were described. The health care
costs ($) / clinical outcome (AC/E ratio) was calculated. Mean total direct costs per patient per month was higher in uncontrolled blood pressure groups compared to the controlled blood pressure groups. The cost-effectiveness relationship was more favourable for diuretics (1.9), angiotensin converting enzyme inhibitors (ACEIs) (2.0), prazosin (2.4) and beta blockers (2.5), more than the diuretics and beta blockers combination theraphy (3.0), calcium channel blockers (CCBs) (3.4) and other combinations (6.1). Antihypertensive drugs used to treat hypertensive patients were different
in their cost-effectiveness ratios. Such results will allow health care professionals and/or decision
makers to make better decisions on how to select treatment options for hypertensive patients in
Malaysia and how to distribute and allocate scarce health care resources. Pharmacoeconomic
evaluations can help in making difficult choices rationally and allocate scarce resources efficiently.
Betulinic acid (BA) is a pentacyclic triterpene found in several botanical sources that has been shown to cause apoptosis in a number of cell lines. This study was undertaken to determine the in vitro cytotoxic properties of BA towards the human mammary carcinoma cell line MDA-MB-231 and the human promyelocytic leukaemia cell line HL-60 and the mode of the induced cell death. The cytotoxicity and mode of cell death of BA were determined using the MTT assay and DNA fragmentation analysis, respectively. In our study, the compound was found to be cytotoxic to MDA-MB-231 and HL-60 cells with IC50 values of 58 μg/mL and 134 μg/mL, respectively. Cells treated with high concentrations of BA exhibited features characteristic of apoptosis such as blebbing, shrinking and a number of small cytoplasm body masses when viewed under an inverted light microscope after 24h. The incidence of apoptosis in MDA-MB-231 was further confirmed by the DNA fragmentation analysis, with the formation of DNA fragments of oligonucleosomal size (180-200 base pairs), giving a ladder-like pattern on agarose gel electrophoresis. BA was more cytotoxic towards MDA-MB-231 than HL-60 cells, and induced apoptosis in MDA-MB-231 cells.
exhibits extensive first pass metabolism with poor oral bioavailability (27%–50%) limiting its therapeutic efficiency. The present study involved an attempt to enhance its aqueous solubility by formulating as solid dispersions (SDs) using sodium starch glycollate (SSG) as a carrier. The dispersions were formulated by dispersion method and evaluated by phase solubility, drug content, in vitro release and mathematical modelling. Solid state characterisation of samples was carried out by X-ray diffraction (XRD), differential scanning calorimetric (DSC), Fourier transform infrared spectrophotometry (FTIR), near infrared (NIR), Raman analysis and wettability studies. The phase solubility and thermodynamic parameters indicated the spontaneity and solubilisation effect of carrier. The release rate from the dispersions was higher than pure drug and found to increase with an increase in carrier content. The optimised dispersions were selected based on release studies, profiles and dissolution parameters. XRD, DSC, FTIR, NIR and Raman analysis proved the crystallinity reduction, changes in crystal quality and compatibility between drug and carriers. Wettability studies proved the increased wettability in selected dispersions. Based on the findings, possible mechanisms that would have contributed to dissolution enhancement of CLZ were suggested. Such findings could be extrapolated to enhance the aqueous solubility of other poorly water-soluble drugs.
This study aims to examine the vancomycin initial dosing and the resultant trough level in paediatric patients. In this retrospective observational study, all therapeutic drug monitoring (TDM) records of paediatric patients admitted to Sabah Women and Children Hospital (SWACH) from January 2011 to September 2013 were reviewed and 116 patients without renal disease were included in the study. Of the total, 38.8% were neonates, 32.8% were infants and 28.4% were children. The majority of the patients were intensive care patients (69.0%) and the most common clinical indication for vancomycin was sepsis (44.8%). The four initial dosing regimens identified were 40 mg/kg/day (38.8%), 30 mg/kg/day (31.0%), 60 mg/kg/day (25.0%) and 45 mg/kg/day (5.2%). The distribution of initial dosing regimen was significantly different between the three age groups (p40 mg/kg/day (p=0.007). The proportions of those who achieved the target therapeutic range (10–20 mg/L) in the 2 dosing groups were 30.9% and 60.0% respectively. In conclusion, the study showed that the initial dosing of >40 mg/kg/day is more likely to achieve the target therapeutic range (10–20 mg/L) compared to the initial dosing of ≤40 mg/kg/day.
Programmes that increase awareness of childhood obesity are vital to reducing the
number of obese adults and adults with cardiovascular diseases. However, the
effectiveness of these programmes must be evaluated to optimise resources for childhood
obesity awareness programmes. The present study was conducted to assess the
intermediate cost-effectiveness and provide a cost analysis of childhood obesity health
promotion programmes. This quasi-experimental study compared the intermediate
outcomes of the Sahabat Sihat and Be Best programmes over a six-month period. Data
regarding health-related quality of life (EQ-5D and EQ-VAS), the Knowledge, Attitude and
Practice questionnaire, and biomedical data were obtained from booklets prepared by
MySihat for childhood obesity-related health promotion programmes. Data regarding cost
was obtained from the expenditure records of the respective health promotion
programmes. The intergroup and intragroup comparisons between the EQ-5D and
EQ-VAS results, the Knowledge, Attitude, and Practice scores, and the biomedical data
were explored using the Mann-Whitney and Friedman tests. Descriptive statistics were
utilised in the analysis of the cost results. Be Best and Sahabat Sihat were successful in
helping to prevent overweight respondents from becoming obese. The Attitude score was
higher among the Sahabat Sihat cohort, but the Practice score was higher among the Be
Best cohort. Be Best had a lower mean cost per participant and was more cost-effective
than Sahabat Sihat.
An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
Individualising a drug dosage regimen is more appropriate if it is based on pharmacokinetics data derived from local populations. In this study, we estimated valproic acid (VPA) and carbamazepine (CBZ) clearances in the Malaysian population from routinely collected therapeutic drug monitoring (TDM) data. We also evaluated the effects of gender, age, weight and concurrent antiepileptic drug (AED) therapy on VPA and CBZ clearance. Data was collected retrospectively from TDM forms of adult patients. Apparent drug clearance was estimated based on the standard steady state clearance equation. Mann-Whitney and KruskalWallis tests were used to evaluate gender and therapy differences, while Spearman’s Rank correlation was used to determine the associations of age and weight with clearance. One hundred thirty-two samples for VPA and 67 for CBZ were included in the analysis. Patients’ ages ranged from 15 to 72 years old. Mean VPA and CBZ clearances were found to be 0.36 l/kg/d and 1.60 l/kg/d, respectively. VPA clearance correlated positively but poorly with weight. Our results showed significant differences in (i) VPA clearance among male and female patients and (ii) VPA clearance between monotherapy and combination therapy. These findings provide a guide to initiate maintenance doses of VPA and CBZ in our local patients. Awareness of factors influencing drug clearance should help to optimise patients’ dosing regimens.
The objective of this research was to formulate an aerosol concentrate containing haruan (Channa
striatus) water extract that would produce a thin film when sprayed onto a wound and could be used for wound dressing. The aerosol concentrates were formulated with various polymer and plasticiser mixtures and tested in dispersion systems. The polymers evaluated were hydroxypropyl methylcellulose (HPMC), carboxymethylcellulose sodium (CMC Sodium), acacia, tragacanth, chitosan, gelatine and gelatine (bloom 151–160), all at concentrations of 2%. The plasticisers evaluated were polyethylene glycol (PEG) 400 and 4000, glycerine, propylene glycol, and triacetin. Films were prepared from film-forming dispersions by casting techniques. Film-forming dispersions were characterised in terms of pH, density, surface tension, rheological properties, particle size distribution, and tackiness. Based on these evaluations, HPMC was chosen as the best polymer. It produced a film with the expected qualities and was easy to reproduce in the form of dispersions or as thin transparent films. Glycerine was judged as the most appropriate plasticiser because it produced the concentrate having the desired qualities and properties expected from an aerosol concentrate.
Studies were conducted to assess the percutaneous absorption of the triacyglycerols (TAGs), tocols and carotenoids present in crude and refined palm oil. In vitro experiments using upright Franz diffusion cells were employed to investigate the permeability of these compounds across full thickness human skin and into the receptor solution. Cetrimide, a cationic surfactant was chosen to be used as a solubilising agent in the receptor phase with an optimum concentration of 3.0 mg/mL and was able to provide sink conditions throughout the permeation. TAGs, tocols and carotenoids all permeated human skin from crude palm oil (CPO), whereas only TAGs permeated when refined palm oil (RPO) was used. Of the TAGs, oleic acid-containing TAGs was preferentially absorbed despite palmitic acid being the most prevalent fatty acid (FA) in TAGs. Tocols in the form of α-T3 showed the highest permeation followed by γ-T3, α-T and the lowest permeation was observed for δ-T3. Carotenoids (α-carotene and β-carotene) also showed an appreciable amount of permeation from CPO.