Clinical Handbook of Antithrombotic : A Practical Guide

Antithrombotic agents are high risk medications associated with significant rates of medication errors. The use of antithrombotic agents is extensively high in cardiology and medical specialties; thus, a good understanding of antithrombotic agents is essential. A group of pharmacists has work collectively to come out with this handbook focusing on antithrombotic agents that commonly established in Sarawak Heart Centre. The purpose of this handbook is to serve as a reference material on antithrombotic agents for pharmacists, nurses, medical officers, medical interns, students and other healthcare providers in the medical field. Therefore, additional basic knowledge of pharmacogenetics and pharmacogenomics information of patients’ response to certain antithrombotic agents are also highlighted in this handbook.I hope the healthcare providers, trainees and students will find this handbook useful during their course of duties

Clinical Handbook of Antithrombotic : A Practical Guide

Antithrombotic agents are high-risk medications associated with significant rates of medication errors. The use of antithrombotic agents is extensively high in cardiology and medical specialties; thus, a good understanding of antithrombotic agents is essential. A group of pharmacists has worked collectively to come out with this handbook focusing on antithrombotic agents that are commonly established in Sarawak Heart Centre. The purpose of this handbook is to serve as reference material on antithrombotic agents for pharmacists, nurses, medical officers, medical interns, students and other healthcare providers in the medical field. Therefore, additional basic knowledge of pharmacogenetics and pharmacogenomics information of patients’ response to certain antithrombotic agents are also highlighted in this handbook. I hope the healthcare providers, trainees and students will find this handbook useful during their course of duties

Quality of life among Patients with Acute Coronary Syndrome in Malaysia

Objectives This study’s objectives were to estimate the quality of life (QOL) of Malaysian patients with acute coronary syndrome (ACS) during admission and at 12 months, to explore the factors associated with the QOL, and to compare utility scores derived from tariffs from local and foreign populations. Methods Data collected from patients with ACS between 2008 and 2009 for a study on cardiac rehabilitation at the Sarawak General Hospital were used for this study. QOL data were obtained using a validated version of the EuroQol five-dimensional questionnaire at baseline and at 12 months. Health utility scores were calculated using visual analogue scale scores and utility tariffs from Malaysia and the United Kingdom. Results Data from 104 subjects from the earlier study was used. The mean age was 56.1 years, with 88.5% being men. The mean hospitalization duration was 6.3 days. The mean utility score was 0.75 at baseline and 0.82 at 12 months. There was a statistically significant improvement in utility from baseline to 12 months based on the Malaysian tariff (P = 0.014) but not with the UK tariff (P = 0.086). The QOL of patients was associated with sex and diagnosis of ST-segment elevation myocardial infarction. Conclusions Our results showed that there was a significant improvement in the QOL from baseline to 12 months. Only sex and diagnosis affected the QOL score at baseline because of limited variables available for testing. It also reconfirms the importance of applying the appropriate, country-specific utility tariffs in QOL studies. Despite limitations, the study is useful toward describing QOL among a group of Malaysian patients with ACS

Comparing The Eq-5d-3l And Sf-6d Utility Scores Of Acute Coronary Syndrome Patients From An Asian Population

Objectives: EQ-5D and SF-6D can both be used to derive health utility scores. Variations in utility scores can have a major impact on the results of cost-utility studies. This study aimed to compare the health utility of acute coronary syndrome (ACS) patients from Malaysia measured by the two descriptive systems Methods: Data was obtained from an earlier study. The study collected data from ACS patients admitted to the Sarawak General Hospital who consented to the study. Validated language versions of the EQ-5D-3L and SF-36v1 were administered during admission and 12-months post-admission. Health utility scores were calculated using the Malaysian EQ-5D-3L utility tariff and Brazier SF-6D algorithm. Patient demographic and clinical data were extracted from medical records

Heavy metals (Cr, Pb, Cd, Ni) in aerosols emitted from electronic cigarettes sold in Malaysia

While past studies have detected heavy metals in aerosols emitted from electronic cigarettes (ECIG), they have provided little information detailing the practical implications of the findings to the Malaysian population due to variations between products. The aims of this study were to analyse heavy metals of interest (HMOI) in the aerosols emitted from selected ECIG and to evaluate potential health risks by referring to the permissible daily exposure (PDE) from inhalational medications defined by the United States Pharmacopeia Chapter 232. All four HMOI were detected in aerosols emitted from the selected ECIG in Sarawak. Among the four, Cr was present at the highest median levels (6.86 ng/m3), followed by Ni (0.30 ng/m3), Pb (0.19 ng/m3) and Cd (0.01 ng/m3). Five out of 100 combinations (5%) of ECIG and ECIG liquids were found to emit Cr that exceed the recommended PDE. Future studies examining more heavy metal variants, using a larger sample size and different analytical techniques to compare various ECIGs are recommended. © 2019, © 2019 Taylor & Francis Group, LLC

Health related quality of life assessment in acute coronary syndrome patients: The effectiveness of early phase I cardiac rehabilitation

Background: Acute Coronary Syndrome (ACS) is one of the most burdensome cardiovascular diseases in terms of the cost of interventions. The Cardiac Rehabilitation Programme (CRP) is well-established in improving clinical outcomes but the assessment of actual clinical improvement is challenging, especially when considering pharmaceutical care (PC) values in phase I CRP during admission and upon discharge from hospital and phase II outpatient interventions. This study explores the impact of pharmacists' interventions in the early stages of CRP on humanistic outcomes and follow-up at a referral hospital in Malaysia. Methods: We recruited 112 patients who were newly diagnosed with ACS and treated at the referral hospital, Sarawak General Hospital, Malaysia. In the intervention group (modified CRP), all medication was reviewed by the clinical pharmacists, focusing on drug indication; understanding of secondary prevention therapy and adherence to treatment strategy. We compared the "pre-post" quality of life (QoL) of three groups (intervention, conventional and control) at baseline, 6 months and 12 months post-discharge with Malaysian norms. QoL data was obtained using a validated version of Short-Form 36 Questionnaire (SF-36). Analysis of variance (ANOVA) with repeated measure tests was used to compare the mean differences of scores over time. Results: A pre-post quasi-experimental non-equivalent group comparison design was applied to 112 patients who were followed up for one year. At baseline, the physical and mental health summaries reported poor outcomes in all three groups. However, these improved gradually but significantly over time. After the 6-month follow-up, the physical component summary reported in the modified CRP (MCRP) participants was higher, with a mean difference of 8.02 (p = 0.015) but worse in the mental component summary, with a mean difference of -4.13. At the 12-month follow-up, the MCRP participants performed better in their physical component (PCS) than those in the CCRP and control groups, with a mean difference of 11.46 (p = 0.008), 10.96 (p = 0.002) and 6.41 (p = 0.006) respectively. Comparing the changes over time for minimal important differences (MICD), the MCRP group showed better social functioning than the CCRP and control groups with mean differences of 20.53 (p = 0.03), 14.47 and 8.8, respectively. In role emotional subscales all three groups showed significant improvement in MCID with mean differences of 30.96 (p = 0.048), 31.58 (p = 0.022) and 37.04 (p < 0.001) respectively. Conclusion: Our results showed that pharmaceutical care intervention significantly improved HRQoL. The study also highlights the importance of early rehabilitation in the hospital setting. The MCRP group consistently showed better QoL, was more highly motivated and benefitted most from the CRP. Trial registration: Medical Research and Ethics Committee (MREC) Ministry of Health Malaysia, November 2007, NMRR-08-246-1401.Scopu

Heavy metals (Cr, Pb, Cd, Ni) in aerosols emitted from electronic cigarettes sold in Malaysia

While past studies have detected heavy metals in aerosols emitted from electronic cigarettes (ECIG), they have provided little information detailing the practical implications of the findings to the Malaysian population due to variations between products. The aims of this study were to analyse heavy metals of interest (HMOI) in the aerosols emitted from selected ECIG and to evaluate potential health risks by referring to the permissible daily exposure (PDE) from inhalational medications defined by the United States Pharmacopeia Chapter 232. All four HMOI were detected in aerosols emitted from the selected ECIG in Sarawak. Among the four, Cr was present at the highest median levels (6.86 ng/m3 ), followed by Ni (0.30 ng/m3 ), Pb (0.19 ng/m3 ) and Cd (0.01 ng/m3 ). Five out of 100 combinations (5%) of ECIG and ECIG liquids were found to emit Cr that exceed the recommended PDE. Future studies examining more heavy metal variants, using a larger sample size and different analytical techniques to compare various ECIGs are recommended

Centroamérica y el TLC: efectos inmediatos e implicaciones futuras

Add.1: Anexo estadísticoIncluye Bibliografí

Pathway for the costing analysis of elective PCI.

<p>Pathway for the costing analysis of elective PCI.</p

Comparison of patient characteristics at TH and GH.

<p>Comparison of patient characteristics at TH and GH.</p