A Study of Organizational Quality Climate in Public Sector

This study was carried out to look at the concept of “Quality First” in the Service organisations in the public sector. For this study, the analysis was done on the dimensions and the factors that influence the organisation’s quality climate. Analysis of the assessment of the climatic factors such as Strategic Focus, Leadership and Management, Work Force, Customer-orientation, and Communication in organisations required the sending out of questionnaires to 97 government organisations in Alor Setar, Kedah Darul Aman. The score of 5.039 was obtained in this study which exceeded the target score of 3.5. This indicates that the organisation climate in the government sector is favourable and conducive for quality improvement effort. The survey showed that managers in the public sector are committed to the quality improvement that the government emphasised upon. Analysis of the factors that influenced the organisation climate shows that there is no significant difference to the size of the work force, size if its budget, the level of government, its function or mission, past performance of total quality effort, and the perception of managers regarding their organisation’s performance. This shows that the organisations in the public sector are the same since they are required to follow the guidelines that the government has put forward in the various circulars pertaining to the quality improvement and implementation. Thus, it can be concluded that public agencies in the govermnent have favourable quality climate which is suitable for any total quality improvement effort required by the government. However, the agencies should nor rest on their laurels but still need to strive for continuous improvement in its total quality effort to achieve the country’s vision 2020

Barriers to optimal control of Type 2 diabetes in Malaysian Malay patients

There are a growing number of people diagnosed with diabetes. But, with the growing number of people diagnosed with diabetes, Malaysia is not spared of this phenomenon, as prevalence stands at 14.9% of adult population. Adequate blood glucose control is vital in diabetes management to prevent complications. Even so there is a lack of diabetic control among people with diabetes in Malaysia and we need to understand why this is. This study set out to explore the perspectives and experiences of Malay patients in managing Type 2 diabetes as a chronic illness and provide recommendations that aim to enhance adherence to treatment and help patients to improve their self-management skills. In-depth interviews were carried out on a purposeful sample of patients and their health care professional (HCPs). Interviews were recorded, transcribed and audiotapes were analysed using NVivo software to identify emerging themes and code according to categories. Interviews were conducted in an Endocrinology clinic in Malaysia with 18 Malay patients (15-75 years, 9 males and 9 females) and 13 HCPs. Results indicated that themes that emerged from interviews with the patients included problems with integrating the treatment regimen and difficulty developing coping skills to achieve the desired blood glucose level. Most patients lacked understanding of diabetes and management of diabetes, nature of diabetes, awareness of having diabetes, diabetic education, knowledge of diabetes, duration of illness, patients’ understanding of diabetes, physical effects of treatment, severity of symptoms and disease. Patients believed that they needed to integrate many treatment requirements such as diet, medications, blood glucose monitoring and exercise into their daily routine. However, barriers to achieving good control of diabetes were found to be the constraints in their ability to control diabetes. Education and knowledge related to diabetes that influenced understanding of the disease were also reasons for non-adherence to treatment regimen. Their beliefs and ability to minimise these barriers shaped their attitudes towards disease management. Patients were willing to discuss their problems about self-managing diabetes if some of these barriers were addressed during consultations. It can be concluded that more positive approaches are needed in self-management of diabetes and health care professionals involved in the management of diabetes need to understand their patients’ beliefs about their diabetes and constraints faced by their patients to promote more awareness and to foster greater control of diabetes and improve health outcomes

Analysing depression using DASS-21 scale among diabetes in Malaysia

Objectives: The study was aimed to verify the correlation and relationship that exist between depression and diabetes, through analysing demographic and disease related variables that may predict depression symptoms among diabetes patients. Methods: Diabetes patients (n=153) aged above 25 years old participated and were required to answer structured questionnaires about sociodemographic traits and the awareness of depression. DASS-21 questionnaires which consist of twenty-one questions examined on three scales;depression, anxiety and stress were used to evaluate depressive symptoms among the subjects. Pearson‘s correlation and multiple regression analysis were performed to assess the association of depressive symptoms with socio-demographic factors of age, gender, race, marital status, level of education and employment status. Habits and behaviours assessments containing six questions were also tested using the same method of analysis. Results: Socio-demographic traits showed significant correlation with the depression level among diabetes patients. Distribution of the patients according to gender showed not much difference in terms of percentage,whereby 51% were females and 49% were males. 6.53% of participants agreed to discuss their problems with depression with physicians. Conclusions: There was significant relationship between diabetes and depression. The underlying causes of depression might vary, thus, further studies should examine other factors that could contribute to depression

PREDICTORS OF GOOD GLYCEMIC CONTROL AMONG TYPE II DIABETES PATIENTS IN PALESTINE

  Objectives: The aim of this study is to assess glycemic control and its relationship with patient characteristics, health-care system factors, and self-care management in type II diabetes patients.Methods: A retrospective cross-sectional study was conducted among 330 type II diabetes patients who met the inclusion criteria and whose medical records covered a period of 1 year. Data concerning patient characteristics, health-care system factors, self-care management, and available last reading of hemoglobin A1c (HbA1c) were collected through personal interviews and a medical records' review using structured questionnaires and data collection forms. Good glycemic control was defined as HbA1c ≤7%. To assess the results, the Statistical Package for Social Sciences (version 16) was used to undertake descriptive, univariate, and multivariate analyses.Results: The mean±standard deviation age was 60±9.7 years. More than half of the participants were male (51.2%), and the majority had additional chronic diseases (88.5%). Of the total 271 participants whose HbA1c levels have been monitored, 16.7% had good glycemic control. Multivariate analysis showed that unemployment was significantly related to a decreased odds of good glycemic control (odds ratio=0.34; 95% confidence interval=0.12-0.98; p<0.05).Conclusion: The study noted that the proportion of patients with good glycemic control was low, a result comparable to studies from many countries. Further investigation and improvement of inappropriate health-care system factors and self-care management together with educational programs that emphasize the importance of self-care management and the health-care providers' role would be of great benefit in glycemic control

Pharmacists’ experiences on adverse drug reaction: 10 years later

Adverse drug reaction (ADR) is one of the leading public health concerns associated with high mortality rate. Healthcare professionals, particularly pharmacists, have a significant role in monitoring and preventing ADRs. This study was conducted on Malaysian Pharmaceutical Society (MPS) pharmacists who worked at the hospitals, health clinics, and community pharmacies to determine if pharmacists’ experiences on ADRs are still the same 10 years later. In 2010, a postal survey and in 2020, an online survey were conducted among these pharmacists. A total of 472 pharmacists and 208 participated in 2010 and 2020, respectively. About 82% and 90% of hospital/health clinic pharmacists (HCPs) observed an ADR over the last 6 months in 2010 and 2020, while 60% and 100% community pharmacists in 2010 and 2020 observed an ADR, respectively. Perindopril was the top drug (HCPs: p = 0.657; CPs: p = 0.98), and rash was the top ADR reported by the pharmacists in both years (HCPs: p < 0.001; CPs: p = 0.679). The most common actions taken by HCPs in 2010 were to report the ADR (p = 0.343), while in 2020, most HCPs explained to patients regarding the reaction (p = 0.061), which was also the same in the CP group in 2020 (p = 0.958). The top factor encouraging ADR reporting in both years and both pharmacist groups was the high degree of severity of the reaction (HCPs: p < 0.001; CPs: p = 0.769). While the top factors discouraging ADR reporting were a lack of information from the affected patients (HCPs: p = 0.2; CPs: p = 0.656), reaction is widely known (HCPs: p = 0.001; CPs: p = 0.144) and uncertainty of the causal relationship (HCPs: p = 0.169; CPs: p = 0.609). Majority of the pharmacists agreed that severe reactions should be reported (HCPs: p = 0.158; CPs: p = 0.501) and the main aim for reporting is to measure the incidence of ADRs (HCPs: p = 0.148; CPs: p = 0.762). Despite being able to identify ADRs during the daily practice, many pharmacists especially community pharmacists are not reporting them. There is a misconception on the purpose of reporting ADRs. An interventional program and ADR reporting training would be a useful step in improving ADR reporting practice

Type 2 diabetes in Malaysia : perspectives of Malay patients and their health care professionals

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Validation and psychometric properties of Bahasa Malaysia version of the depression anxiety and stress scales (DASS) among diabetic patients

Background: Having a validated questionnaire in any field would nurture a research path in that particular area. The aim of this study was to validate the Depression Anxiety Stress Scales 21-item (DASS-21) Bahasa Malaysia BM) version among clinical subjects who were diabetic patients. Objectives: To determine the reliability and construct validity of the BM DASS by looking at internal consistency and exploratory factor analysis respectively. Methods: The BM DASS was administered to a total of 153 diabetic patients. These patients were selected when they came to 15 retail pharmacies all over the Klang Valley. Results: The BM DASS-21 had very good Cronbach’s alpha values of 0.75, 0.74 and 0.79, respectively for depression, anxiety and stress subscales. For construct validity, it also had good factor loading values for 17 out of 21 items (.31 to .75). Conclusions: The results of this study entrenched the evidence that the BM DASS-21 had excellent psychometric properties and therefore it is suitable to be used for the Malaysian clinical population

The prevalence of adverse drug event-related admissions at a local hospital in Malaysia

Aims: To determine the prevalence of adverse drug event (ADE)-related admissions and the related drugs. Setting and Designs: This study was conducted prospectively in two medical wards in Malaysia. Subjects and Methods: Information was collected from patients′ medical and medication charts over a period of 24 weeks. All screened patients were assessed using a list of criteria and were classified into: Therapeutic failure (TF), adverse drug reaction (ADR), medication error (ME), and drug overdose (DO). Patients admitted due to ADEs and its subcategories were analyzed and presented in counts and percentages. The prevalence of ADE-related admissions and the drug associated with each category were identified and calculated. Results: Out of 1,200 screened patients, 39% (n = 443) were ADE-related admissions. A total of 483 ADEs were identified; 79% (n = 351) were due to TF, 21% (n = 94) were due to ADR, 5% (n = 21) were due to DO, and 3% (n = 15) were due to ME. Cardiovascular drugs, antidiabetics, and antiasthmatics were most commonly associated with these admissions. The most common complaint by patients admitted due to a TF was chest pain, whilst hypoglycemia was the main cause of admission related to ADRs. Conclusions: The prevalence of admissions related to ADEs is high in Malaysia and this was mainly contributed by admissions related to TF. Some useful strategies such as educational interventions on the main causes of ADEs, monitoring of patients prescribed with drugs most commonly associated with ADEs, and appropriate prescribing should be targeted at all healthcare professionals to prevent future occurrences. However, further investigation is needed to clarify the high proportion of patients admitted due to TF

Dosing of amino acids in the parenteral nutrition in very low birth weight preterm neonates: an outcome assessment Running Title: Use of amino acids in preterm neonates

ABSTRACT This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2.00 (&lt; 28 weeks group); 1.00 (28-31 weeks group) and 0.75 (&gt;31 weeks group). Neonates in the &lt; 28 weeks group were more likely to receive AA at an earlier time and higher initial dose compared with the other age groups. The study also found that there was no statistically significant difference in the dose of AA on the first day of PN administration and that the significant variations in nutritional parameters among the subjects did not lead to differences in physical outcomes. This study identified that when PN is provided in the local hospital setting, it is likely that the current nutritional practices are inadequate to achieve the standard growth recommendations. Our findings call for a need to optimize AA and calorie intake since growth restriction is a morbidity which will affect the infants&apos; growth and development. Current prescriptions for PN in this hospital need to be reviewed in order to improve patient outcomes