Objective: The main objective of this study is to compare patients’ outcome in anticoagulation treatment before and after Warfarin Medication Therapy Adherence Clinic (WMTAC). The study compares the cost of INR test between usual care (UC) and WMTAC. The study also determines factors affecting International Normalized Ratio (INR) level among WMTAC patients.
Methods: A retrospective study involving WMTAC patients was conducted by trained pharmacists at Dungun Hospital. Patients were reviewed by UC for 4 months and continuously followed up by WMTAC for another 4 months were included in this study. Patients who passed away, transferred out and defaulted were excluded from the study. The data were derived from Patient Medical Record and recorded in Warfarin Data Collection Form for analyze.
Results: The time in therapeutic range (TTR) was 73.46% for WMTAC and 45.58% for UC (p
Introduction: All pharmaceutical products in Malaysia must be registered with the Drug Control Authority (DCA) whereas cosmetics must be notified with the National Pharmaceutical Regulatory Agency (NPRA). Availability of unregistered products and unnotified cosmetics in the market are longstanding issues affecting public safety and health. It is vital that all government healthcare personnel (GHP) as the front liners are equipped with the knowledge to properly advise the public on this issue.
Objective: This study aims to determine the level of knowledge towards registered products and notified cosmetics among various groups of GHP under the Ministry of Health facilities in Labuan.
Methods: This was a cross-sectional study performed from August to November 2017 using a validated 12 question questionnaire. Respondents were divided into 4 groups (doctors/dentist, pharmacist, nurse, allied healthcare professional) and results between the groups were analysed using Chi-square analysis. Respondent’s knowledge was given score and those who scored 9 marks and above were considered to have good knowledge. Those who scored 8 marks and below were considered to have poor knowledge.
Results: Only 40.2% Pharmacists have the highest score of good knowledge on registered products and notified cosmetics at 81.8% (n=18). The level of good knowledge among allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors (n=6). However in total, only 40.2% (n=88) of the study population had good knowledge.
Conclusion: The level of knowledge towards registered products and notified cosmetics among doctors, pharmacist, nurses and allied health professional in Labuan is poor as only 40.2% have good knowledge. This study shows a significant association between the levels of knowledge among GHP varies between groups of profession. Pharmacist group has the highest score in knowledge in this study and thus should be another reference for the general public and patients when it comes to health-related matters. Further re-education should be conducted to improve the knowledge of GHPs in Labuan with regards to this subject.
This study aimed to assess the adequacy of EQ-5D-5L in defining health as perceived by Malaysians
using a mixed methodology approach. Potential additional dimensions (i.e. bolt-on items) to supplement
the current instrument were also explored. This study was carried out in two phases. In phase one, focus
group discussions (N = 6-8 in each group) were employed to gauge the perception of Malaysians on the
dimensions deemed important additions to the EQ-5D-5L instrument. Phase two involved further
validation of bolt-ons to the EQ-5D-5L using a cross-sectional survey of 100 general public in Penang,
Malaysia. A total of 11 bolt-ons were identified from phase 1. These bolt-ons were sleep, vitality,
happiness, close relationships, stress, mental abilities, social support, religion, vision, hearing, and
speaking. In phase 2, the bolt-ons of ‘vitality’ and ‘stress’ stood out with 70% (n=70) and 64% (n=64)
participants reported facing most problems with, respectively. Both phases of study suggest that
additional dimensions for the existing EQ-5D-5L instrument may be useful to better capture the HRQoL
among Malaysians. Larger scale study is warranted to further validate the bolt-ons identified in this
study.
Background: Dual therapy with aspirin and clopidogrel is the standard treatment for acute
coronary syndrome (ACS). Dual antiplatelet therapy plays an important role in reducing major
acute, short- and long-term adverse clinical outcomes. Currently, the economic evaluation of
ticagrelor, a reversible and direct-acting oral antagonist of adenosine diphosphate receptor
P2Y12 remains unknown.
Objective: To compare the annual cost of ticagrelor versus branded clopidogrel in patients with
ACS from a Malaysian health care perspective.
Methods: The data required for this analysis was obtained from a 2007 study carried out by
Fong et al. in ACS patients (n=57). Assumptions used for the present analysis were based on
data from the Cardiac Rehabilitation Program (CRP) study, the Study of Platelet Inhibition
and Patient Outcomes (PLATO) and the National Cardiovascular Disease ACS (NCVD ACS)
registry of Malaysia. For all calculations, the Ringgit Malaysia (RM) currency and prices as of
2007 were considered.
Results: The cost of clopidogrel treatment in post-ACS patients for 30 days was calculated to
be RM1,381,340 (n=2072; daily cost=RM5.50) and assuming treatment with ticagrelor, the
cost would be RM1,554,000 (daily cost=RM8.70). Based on PLATO and NCVD ACS 2007,
it was estimated that major adverse coronary event (MACE) in the form of unstable angina
(UA) would occur in an additional 21 patients on clopidogrel, which could have been avoided
with ticagrelor. Extrapolating cost data from CRP study, it was estimated that the annual costs
for 21 additional cases of UA in terms of annual treatment and readmission would be more
than RM400,000. Treatment with ticagrelor would thereby be associated with lesser number of
MACE that can be translated in avoiding annual costs of treatment of UA and result in annual
cost savings of RM238,856.
Conclusion: Although direct comparisons were not made, this analysis suggests that ticagrelor
therapy may be a more cost-saving alternative to clopidogrel in Malaysian patients with ACS.
Essential medicines have become indispensable to maintain and to improve our lives and health. Latest literature again reiterated that inappropriate use of medicine is a global phenomenon in both developed and developing countries still prevail. Poor adherence is associated with negative clinical outcome of the disease. It is important to note that about 50% of treatment failures are due to poor medication adherence and this results in substantial morbidity and mortality. Patient’s belief and perception have been reported to influence medication adherence. Low rate of adherence was found strongly associated with patient’s belief across the studies with chronic diseases with hypertension, coronary heart disease, diabetes, asthma and renal disease. Exploring the health beliefs of patients is vital to improve adherence and thereby blood pressure among the patients with hypertension. Lack of knowledge about usage of medication and various misleading perceptions of hypertension management have resulted inappropriate use of medication especially medication adherence among community-dwelling patients with hypertension. Literatures classified non-adherence into primary and secondary. Primary non-adherence refers to medication is purposefully never filled or taken; Secondary non-adherence is defined as medication is not taken properly or continued as prescribed and further classified into intentionally and unintentionally. Patient education aims to train patient in the skill and self-management of their chronic disease by adapting to the treatment or lifestyle changes. Despite improving in patients’ skill and self-care by providing information about the treatment, patient education could enhance their empowerment and medication adherence. Patient education is a basic right of the patients and healthcare members have responsible to provide such information. However, the authenticity of the available information is yet to be verified. Therefore, healthcare professional could play a vital role here to educate their patients about the appropriate information.
Introduction: In the context of pharmacy education worldwide and in Malaysia, the use of digital
technologies to promote higher level thinking and discussions is seen as preparing the millennials as
pharmacists in the 21st century. Together with leveraging on millennials' penchant for mobile
technology, gamified online quizzes as an assessment tool that help promote active and collaborative
learning in a Medicinal Chemistry course have been used. Objectives: This study investigates
students’ perception of the impact of gamified online quizzes on their learning in a Medicinal
Chemistry course. Method: This study employs mix method research comprising descriptive
analysis, content analysis from informal chats and researchers' observation to gather the findings for
the study. Three gamified online quizzes using Quizizz, were implemented outside classroom time,
in place of traditional quizzes. Multiple attempts were allowed within a stipulated time. As
interventions, post-quiz discussions were conducted during class time. Students completed an endof-
the-course survey. Results: Out of 63 respondents, more than 96% felt that the gamified online
quizzes enhanced their learning as they learned from the instant feedback, their mistakes and postquiz
discussions. Overall student performance based on the percentage and accuracy of answering
the quiz improved with time. Student qualitative comments on the survey, the course social media
(closed group) and informal chats supported the findings from the descriptive data analysis of the
study. Conclusions: From students’ perception, the gamified online quizzes were found to be
enjoyable and effective in enhancing active, peer learning in an undergraduate medicinal chemistry
course outside class time. For instructors, the online quiz served as an efficient tool for formative
assessment in a large classroom setting, and could replace traditional classroom quizzes.
Dikir Farmasi (DF) is a new effort to expand and intensify the dissemination of information about
the regulation of the legitimate use of drugs and cosmetics. This study was aimed to explore the
opinions of Pharmacy Enforcement Division staff and the general public regarding the quality and
impact of DF program as a health promotion tool in Malaysia. A qualitative study using semistructured
interviews and focus group discussions (FGDs) were conducted at the Pharmacy
Enforcement Department and three health clinics located at the city of Kota Bharu, Malaysia. The
interviews were audio recorded, translated and transcribed. Thematic analysis was performed to
identify the themes and sub-themes of the transcripts. Ethical approval was obtained from Ministry
of Health Malaysia. All respondents provided a written consent for participation. Nine pharmacy
officers and 23 general public participated in this study. Five main themes emerged from the
information gathered and analyzed: 1) language; 2) design; 3) content and delivery 4) costs and
benefits and 5) prospect of DF. Certain weaknesses of DF have been raised and the health authorities
could utilize this information for an improvement. Significant effort must be made to improve the
publicity and dissemination of DF to ensure that it reaches the target population. Certain weaknesses
of DF have been raised and the health authorities could utilize this information for an improvement.
Significant effort must be made to improve the publicity and dissemination of DF to ensure that it
reaches the target population.
Introduction: Lipid-modifying drugs have been used to treat dyslipidemia as well as for the primary
and secondary prevention of CVDs and stroke. Objectives: This study aims to describe the drug
utilization pattern of lipid-modifying drugs in a private hospital. Method: A retrospective study was
carried out in outpatient of the selected hospital. Patients were selected based on inclusion and
exclusion criteria by using convenience sampling. Data were collected through KCIS by retrieving
patients’ registration number. Defined daily dose (DDD) was calculated and compared to World
Health Organization DDD. Medicine prices were also analysed. Results: A total of 180 patients’
record were analysed, 70% of them were male; 40.6% of the patients were from the age range of 50
to 59 years old; ethnicity breakdown was Malay (69.4%), Indian (18.3%) and Chinese (12.2%).
Among all lipid-modifying drugs, utilization of statins was the highest as statins are the preferred
line in the treatment of dyslipidemia. Innovator brands were more preferred where most of the lipidmodifying
drugs used in the selected hospital are innovator brand drugs. In terms of cost, lipidmodifying
drugs contributes to about 27% of the total cost of prescription in average. Conclusion:
The utilization of all lipid-modifying drugs in the selected hospital was lower as compared to WHO
DDD. As compared to combination therapy, monotherapy with atorvastatin was generally preferred
in the selected hospital. The utilization of atorvastatin was found to be the highest in the OPD of the
selected hospital.
The management of Valproic Acid (VPA) toxicity is mainly supportive treatment. Invasive management such as hemodialysis (HD) and hemoperfusion were only used in isolated cases where patient is highly VPA toxic, which results in coma. We described a case of mild VPA toxicity (VPA serum concentration 326.42mcg/mL), where the patient was successfully treated with two hours of low-flux HD with no complication. While the guideline of indication of HD in VPA toxicity has yet to be published, low-flux HD can be an effective treatment in cases of mild VPA toxicity, if other supportive measures failed or not available.
The objective of this study is to look into the stability of Chloral Hydrate 40 mg per ml formulated as oral solution in X-temp Oral Suspension System in order to select proper storage conditions and establish beyond-use date. X-temp is a novel oral, flavoured sugar-free extemporaneous compounding vehicle to assist in the preparation of extemporaneous dosage forms.
The compounded solution of 40 mg/ml was prepared by dissolving chloral hydrate powder in X-temp vehicle. The solution was then packed in amber HDPE containers, and were stored at refrigeration 5 ± 3°C and room temperature 30°C. Physical, chemical and microbiological parameters were evaluated at predetermined time-points up to 180 days. Samples were tested using a validated stability–indicating assay. Chloral hydrate concentration was assayed by high-performance liquid chromatography (HPLC).
The stability results indicated that the solution remained unchanged in visual appearance or pH at both refrigeration and room temperature for up to 180 days. The HPLC results showed that all the stability studies maintained 90 – 100% of initial drug concentration. There was no substantial changes in the microbiological stability.
Chloral hydrate solution prepared in X-temp Oral Suspension System was stable for up to 180 days when stored at room temperature and refrigeration conditions. These results demonstrated that X-temp is a suitable vehicle for extemporaneous compounding for chloral hydrate.
Many drugs used in paediatric are often not available in suitable dosage forms and have to be
extemporaneously prepared by pharmacists to make them suitable for the body weight, body
surface area, or age of the children. Phenobarbitone is the main anti-epileptic drug (AED) for
the treatment of seizure in paediatric patients. The objective of this study is to evaluate the
physicochemical and microbiological stability of an extemporaneously prepared
Phenobarbitone Oral Suspension using commercially available tablets and X-temp Oral
Suspension System. The Phenobarbitone Oral Suspension (10mg/ml) was stored at 4ºC and
30ºC / 75%RH protected from light and were examined at the interval of 0, 1, 2, 3 and 6
months. The content of Phenobarbitone was determined using a validated high-performance
liquid chromatography (HPLC) method. The visual appearance, odour, pH and specific
gravity remained fairly unchanged throughout the study period and the content of
Phenobarbitone remained above 98% of the original concentration throughout the course of
the study for both temperatures. The extemporaneous preparation was not susceptible to
microbial contamination. The results from the stability studies confirmed that X-temp Oral
Suspension is a suitable suspending vehicle for preparing extemporaneous liquid formulation
of Phenobarbitone Oral Suspension with the added advantage of alcohol-free, colourant-free
and sugar-free. Based on the data collected, the shelf-life of this liquid formulation is at least
6 months when stored at 4ºC (refrigeration) and 30ºC / 75%RH (room temperature).
An exploratory study to ascertain the public’s awareness of community pharmacy
and pharmacists in a selected subset of the Malaysian population was undertaken,
utilising an interviewer-administered structured questionnaire approach. A total
score was computed for each respondent, ranging from a possible minimum of 0 and
a maximum of 24. The scores achieved were arbitrarily categorised into poor (19) levels of general knowledge
regarding community pharmacy and pharmacists. The scores achieved ranged from
3 to 21, with an average “fair” score of 13.7. The results showed that 93.6% of the
respondents (n = 561) interviewed had heard of the term “pharmacist” before.
Interestingly, 17.5% of the respondents were of the opinion that pharmacists
worked on farms. A significant 77.4% perceived that a pharmacist served in a
doctor’s clinic. It was noted that 84.1% of those surveyed would go to doctors for
advice on medicine, while only 49.4% would seek a pharmacist. A majority (76.7%)
of the respondents interviewed chose to go to a doctor’s clinic for a screening test.
The study amplifies the need for a more aggressive projection of the pharmacist’s
image in the community in order to be recognized and accepted by the public as an
integral partner in the health care profession.
A cross-sectional study was conducted among pharmacy students to determine
factors influencing their choice of work place and to evaluate whether a one-year
hospital pre-registration training programme had any effect on these choices.
Questionnaires were distributed to graduating students at the School of
Pharmaceutical Sciences, Universiti Sains Malaysia. The questionnaires were again
sent to the same group of students by post at the end of their pre-registration
training year. The response rate during the follow-up stage was 46%. Results
indicated that students in the survey were more interested in independent and chain
community pharmacies compared to other practice settings. Students’ choices of
first place of practice appeared to be influenced by both intrinsic and extrinsic job
factors. Our findings did not show major changes in students’ preferences for
practice sites before and after the hospital pre-registration period. This information
is expected to be useful for pharmacy employers.
Bioethics was originally proposed in the early 1970s to denote ‘the incorporation of
biological knowledge and human values’. It is becoming more relevant in the
biological age. This paper looks at some of the biological issues that require an
ethical input. These include the Human Genome Project, human cloning and
assisted reproductive technologies, contraception and abortion, organ donation and
transplantation, euthanasia, brain death, human embryonic cells and AIDS.
Examples of issues that have been raised in this area: Who owns our genes? Can we
‘design’ our babies? Should humans be cloned? Can pregnancy be terminated? Is
mercy killing all right? Is brain death equivalent to death? Can embryonic cells be
used in experiments? While some have been settled, others still persist till today.
The numerous ethical questions pertaining to biology beg serious efforts on the part
of ethical theorists to dig deep into their established principles. Similarly those
working within applied ethics cannot operate effectively without referring to
theoretical ethics. Hence thus far, many of the bioethical issues have been tackled. It
is proposed that as a member of the health team, pharmacists too need to be well
versed in issues pertaining to bioethics.
A HPLC method for the detection and quantification of glibenclamide, from
dissolution studies of glibenclamide tablets (5 mg), was developed. The dissolution
test employed was the basket method, operating at 100 rpm, using 1000ml
phosphate buffer pH 7.4 as the dissolution medium. Elution was performed on LC-
18 reverse phase, SupelcosilTM ODS column (4.6mm x 25cm, 5μm) using a mobile
phase consisting of 0.02M monobasic ammonium phosphate in 60%v/v acetonitrile
in water at a flow rate of 2ml/min, using phenacetin as the internal standard. The
eluent was monitored at 254nm with an UV detector. Retention times of the
glibenclamide and phenacetin peaks were 3.61 minutes and 1.8 minutes respectively.
Pharmacists in Malaysia practise their profession in rugged terrains which demand
both professional skills and pioneering spirits. Many of the current pharmaceutical
standards, practices, and legislations need overhauling in order to meet the
aspiration of the nation in this new millennium. The Malaysian Pharmaceutical
Society has a vital role to play. The profession requires the greatest understanding
of the Malaysian Medical Association and the Government in this transition period.
The Falsified Medicines Directive (FMD) imposes strict serialisation requirements on pharmaceutical manufacturers, distributors and dispensers. This article outlines everything you need to know and what you need to do for a seamless serialisation process – before regulators remove your right to trade.
Pharmaceutical manufacturers are currently the main actors in a serial drama where getting their lines right is paramount. Well, four lines of data, to be precise; in (and next to) DataMatrix barcodes applied to every pack of prescription medicines. The introduction of serialisation, designed to ensure the authenticity and traceability of individual medicines, promises to improve patient safety and create exciting opportunities for digital health. But there is a twist in the plot. Failure to comply with the EU regulation that mandates it means you cannot legally ship your product. No barcode, no trade. That is when a serial drama turns into a tragedy. And time is running out to be ready.
The unfolding story of the Falsified Medicines Directive (FMD), which was first introduced in 2011, is into its final episodes. The denouement arrives on February 9, 2019, when the Directive is fully enforced and the penalties for non-compliance officially come into play. FMD is an attempt to prevent inauthentic, substandard or harmful medicines entering the supply chain. It imposes strict serialisation, traceability and verification requirements on pharmaceutical manufacturers and their associated wholesalers, distributors and contract manufacturers. In particular, it mandates companies to print a unique identifier on the packaging of prescription medicines. Furthermore, companies are not just responsible for the data that goes on the packaging, they are responsible for submitting it to the central data hub that will enable pharmacists to authenticate products before they dispense them. It is a complex undertaking that could be easily underestimated – but not if you understand some key steps. The implementation of serialisation is not an overnight task – it encompasses processes that have multiple touch-points across global organisations, partner networks and the wider supply chain. Yet despite this – and despite the enormous implications of getting it wrong – many companies are still some distance from being fit for purpose. Indeed, in some organisations, the Directive has not yet hit their radar. It needs to – because the clock is ticking. But all is not lost. Here are seven steps to successful serialisation.
Anti-peptic ulcer drugs (APUDs) such as proton pump inhibitors (PPI), H2 receptor antagonists (H2A), antacids are widely prescribed. This study is aimed to describe the utilisation pattern of APUDs based on WHO Defined Daily Dose (DDD) and identify most commonly used APUD in the selected hospital. A retrospective study was carried out in outpatient of the selected hospital for year 2017. Sample size was calculated using Raosoft. DDD of APUDs and direct drug cost were calculated. Data were collected through electronic medical record by retrieving patients’ registration number. Inclusion criteria were patients above 18 years old and APUDs prescribed for gastrointestinal related indications. A total of 160 prescriptions were randomly selected for data analysis. Based on the DDD calculated, Rabeprazole 20mg was most prescribed drug among PPI (n=33), while Maalox is most prescribed drug among the antacids (n=23). Based on the DDD calculated, Pantoprazole 20mg recorded highest rates per user per day about 1.26 DDD / user / day while antacids, Actal reported highest usage rate with 7.11 DDD / user / day. Besides, there are 5.4 days supplied per user for this drug. Dexlansoprazole 60mg is the most expensive drug among all the PPI listed in hospital formulary. It has 18.5 days supplied/user, which is the second shortest duration of treatment among all the other PPIs. In contrast, omeprazole 20mg is the lowest cost PPI but the duration supplied per user is longer resulting in higher total cost of therapy. In conclusion, PPIs were the most commonly prescribed.