Cost evaluation of therapeutic drug monitoring of gentamicin at a teaching hospital in Malaysia

Background: Therapeutic drug monitoring (TDM) makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i) cost of laboratory and clinical investigations, (ii) cost associated with each gentamicin dose, (iii) fixed and operating costs of TDM service, (iv) cost of providing medical care, and (v) cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5%) had TDM service for gentamicin. Seventy-three percent (49/67) patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02). Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization

Attitudes and beliefs of patients with chronic depression toward antidepressants and depression

BACKGROUND: Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates. OBJECTIVES: The primary aim of this study was to determine the attitudes and beliefs of patients with depression toward depression and antidepressants. A secondary aim was to assess the influence of ethnicity on patients' attitudes and beliefs. PATIENTS AND METHODS: The study involved patients with chronic depression being followed up at an outpatient clinic at a government-run hospital in Malaysia. Patients' attitudes and beliefs were assessed using the Antidepressant Compliance Questionnaire. RESULTS: A total of 104 patients of Malay, Chinese, and Indian ethnic groups met the selection criteria. Chinese patients had significantly negative attitudes and beliefs toward depression and antidepressants compared to Malays and Indians (b=-8.96, t 103=-3.22; P<0.05). Component analysis revealed that 59% of patients believed that antidepressants can cause a person to have less control over their thoughts and feelings, while 67% believed that antidepressants could alter one's personality; 60% believed it was okay to take fewer tablets on days when they felt better, while 66% believed that antidepressants helped solve their emotional problems and helped them worry less. CONCLUSION: Patients had an overall positive view as to the benefits of antidepressants, but the majority had incorrect views as to the acceptable dosing of antidepressants and had concerns about the safety of the medication. Assessing patients' attitudes and beliefs, as well as the impact of their respective cultures, can be used in tailoring psychoeducation sessions accordingly

Perception of community pharmacists in Malaysia about mental healthcare and barriers to providing pharmaceutical care services to patients with mental disorders

The aim of this study was to assess community pharmacists’ perceptions toward mental healthcare, and the barriers faced in providing pharmaceutical care services to these patients. A 40-item survey was posted to community pharmacists. Ninety-six pharmacists participated. The majority (84.2%) agreed there is a role for community pharmacists to play in mental health care, while approximately 60% agreed it is their responsibility to provide pharmaceutical care to these patients. The biggest barrier to providing this service is the lack of knowledge, cited by close to 50% of respondents. This corresponds with the revelation that close to 60% believe that they have a poor or fair understanding of mental disorders. About 30% of respondents said they do not stock psychotropic drugs at all, mainly due to medico-legal reasons, and low prescription requests. Our findings highlight the need for more training of community pharmacists in managing patients with mental disorders

Psychometric properties of knowledge, attitude, and practice on pharmacogenovigilance in drug safety questionnaire in medicine and pharmacy students: based on Exploratory Factor Analysis

Integration of Pharmacogenomics and Pharmacovigilance in the curricula of future healthcare professionals isessential towards individualized medicine and drug safety. Researchers are lacking in Knowledge, attitude and practice regarding pharmacogenovigilance in drug safety among Malaysian future health professionals. Thisstudy is to develop and validate a reliable questionnaire for evaluation of knowledge, attitude and practice of future Doctors and Pharmacists concerning Pharmacogenovigilance in drug safety. A 49-item self-administeredquestionnaire was developed from the literature. The content was validated by a panel of relevant expertsfollowed by face validity. A pilot study on 100 respondents was conducted for reliability, followed by a crosssectional study involving 247 participants in factor analysis. The content validity index of the wholequest ionnaire was 0.8%. The overall Cronbach‟s Alpha was 0.8, with P<0.001. 67.4% of the total variance wasexplained by 13 factors, and we can conclude that the questionnaire is a valid and reliable instrument

Optimization of boron dispersion on fibrous-silica-nickel catalyst for enhanced CO2 hydrogenation to methane

There are numerous reports regarding boron-containing catalysts for hydrogen-related reactions from CO2 including dry reforming of methane and methanation. Besides enhancing the productivity, boron also improved nickel activity and stability. However, the detailed mechanistic study, particularly in explaining the starring role of boron in the enhanced reactions, is still lacking. Thus, herein we loaded boron on fibrous-silica-nickel and investigated their physicochemical properties and mechanistic route by means of in-situ FTIR for enhanced CO2 methanation. It was found that the appropriate dispersion of boron surrounds the nickel particles is an important factor to improve the adsorption of CO2 before interacting with split hydrogen atom from the nickel sides to form intermediates which are subsequently dehydrated, and then serial hydrogenation gave the final product of methane. Boron also accelerated the methanation and restricted coke formation. A hybrid approach on optimization via a face-centered central composite design and a response surface methodology showed that reaction using H2/CO2 ratio of 6, GHSV of 10,500 mL g−1 h−1, at 500 °C gave the highest percentage of CH4 of 84.3%. To indicate the error, the predicted values were compared to the experimental values, yielding an accurately minimal error ranging from 0 to 11%. As a result, the empirical models generated for CO2 hydrogenation to methane were reasonably accurate, with all actual values for the confirmation runs fitting within the 94% prediction interval

EVALUATION OF BLOOD SAMPLING TIMES AND INDICATIONS FOR THERAPEUTIC DRUG MONITORING SERVICES

The appropriateness of sampling times and indications for monitoring of serum drug concentrations for the purpose of therapeutic drug monitoring (TDM) were evaluated at three hospitals on the east coast of Malaysia. Appropriateness criteria for indication and sampling were adapted from previously published criteria and with input from local TDM pharmacists. Six drugs were chosen, namely gentamicin, digoxin, carbamazepine, phenobarbital, phenytoin, and valproic acid. A total of 265 TDM requests were evaluated. Appropriateness of the indication for TDM ranged from 77.4% to 82%, while that for sampling ranged from 34.2% to 62.1%. There were no significant differences between the three hospitals in both categories of appropriateness. Among different drug groups, the percentage of appropriate indication was found to be highest with antiepileptic drugs. Antiepileptic drugs, however, had the lowest rate of appropriate sampling. Overall, findings from the three hospitals showed very encouraging results with almost 80% of the requests considered as appropriately indicated. However, the percentage of appropriateness of sampling was lower, and thus may require further investigation

PHARMACOKINETIC PARAMETERS OF VALPROIC ACID AND CARBAMAZEPINE FROM ROUTINELY COLLECTED DATA: INFLUENCE OF PATIENT CHARACTERISTICS

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 Kruskal-Wallis 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

Intra-peritoneal antibiotic utilization among Continuous Ambulatory Peritoneal Dialysis (CAPD) patients with peritonitis at a tertiary hospital setting in Malaysia

Introduction: Patients using CAPD are commonly associated with peritonitis. Peritonitis is a significant cause of morbidity, mortality and permanent transfer to haemodialysis in these patients. However, little is known about the utilization of antibiotic for the treatment of peritonitis in patients using CAPD. Objectives: This study aimed to evaluate the patterns of intra-peritoneal antibiotics utilization for the treatment of peritonitis in CAPD patients. Materials and Methods: This was a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry during 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the ATC/DDD system. Results: A total of 105 peritonitis episodes were recorded from 72 patients. The most common first line empiric combinations used were ceftazidime/cefazolin (42%, n=), followed by cefepime/cefazolin (32%,n=) and ceftazidime/cloxacillin (27%, n=). For the definite therapy after obtaining the culture and sensitivity report demonstrated that vancomycin was the most prescribed (33.64%, n=), followed by meropenem (14.95%, n=) and ciprofloxacin (% , n=) . Although ciprofloxacin was the least antibiotic prescribed for CAPD-related peritonitis, the DDD/100patient-days estimates showed that its therapeutic intensity were the highest. Conclusion: There were various intraperitoneal antibiotics used for CAPD-related peritonitis and the most common empirical therapy was the combination of ceftazidine and ceftazolin while vancomycin was predominately used for definite therapy. Future studies to evaluate the clinical outcomes of the antibiotic use to have a better insight on the efficacy of the peritonitis treatment, hence better quality of patient care