A pragmatic cluster randomised controlled trial to evaluate the effectiveness of the EMPOWER-PAR intervention in improving primary care provides' adherence to T2DM CPG and medication adherence in T2DM patients / Maryam Hannah Daud

Background: Numerous local studies have shown that there were poor adherence to T2DM clinical practice guideline (CPG) recommendations among primary care providers (PCP) and poor medication adherence among T2DM patients in primary care. The Chronic Care Model (CCM) had been proven to be effective in improving providers' adherence to CPG and medication adherence among T2DM patients in developed countries. However, evidence in developing countries is still lacking. Objectives: The first objective of this study was to design a pragmatic intervention based on the CCM i.e. EMPOWER-PAR intervention. The second objective was to evaluate the effectiveness of this intervention in improving the PCPs' adherence to T2DM CPG, medication adherence level and clinical outcomes among T2DM patients in the Malaysian public primary care setting. Methods: This is a sub study of a larger pragmatic cluster randomized controlled trial - participatory action research which was conducted in 10 public primary care clinics in Selangor and Kuala Lumpur. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another 5 clinics continued with usual care. The PCPs' adherence to T2DM CPG was measured using the 'Process of Care Questionnaire', which includes the indicators of care as recommended by the Malaysian CPG on the Management of T2DM. Data were collected from the patients' medical records, retrospectively at baseline and at 1-year follow-up. Medication adherence levels among T2DM patients were measured using the previously validated Malay version of the Morisky Medication Adherence Scale - 8 (MMAS-8). Data were collected using face-to-face interview by trained interviewers, at baseline and at 1-year follow-up. Clinical outcome data were collected at baseline and at 1-year follow-up. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for the baseline differences and the clustering effect. Results: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the percent change of the level of PCPs' adherence in the intervention compared to the control group at 1-year follow-up in several indicators of care. The intervention improved medication adherence levels twice more likely compared to usual care (adjusted OR 2.18, 95% CI 1.55 - 3.06, p-value<0.001). The proportion of patients achieving HbAlc target in the intervention group was significantly higher compared to the control groups (18.0% vs. 12.5%, p-value=0.022). The intervention also improved the proportion of T2DM patients achieving HbAlc target twice more likely compared to usual care (adjusted OR 2.34, 95% CI 1.22 - 4.51, p-value<0.011). Conclusions: The EMPOWER-PAR intervention has been proven to be effective in improving the PCPs' adherence to T2DM CPG in several indicators of care, patients' medication adherence levels and the proportion of patients achieving HbAlc target. Findings from this study provided objective evidence of the effectiveness of this intervention in the Malaysian public primary care setting

Global leadership for a reputable university

In Malaysia the concept of a reputable university is very hotly debated. It was a hot issue when an opposition Member of Parliament mentioned that Malaysian universities are not ranked among the top 100 world universities. Some of our premier universities did poorly in the ranking. One of the key factors of transforming Malaysian universities into reputable universities is leadership. In the context of globalization, Malaysian universities need leaders who can work on a global stage. This study attempts to understand the concept of global leadership, which is important for leading a university of international repute. This research employed qualitative means, utilizing the in-depth interview for data collection. Data were collected from eight past and present top leaders of a university in Malaysia. The data collected from the interviews were then transcribed verbatim, coded, analyzed, interpreted and discussed accordingly. There are various factors that will enable our universities to become internationally reputable universities. Among others are abundance of resources, quality academicians, quality students and good governance. Based on the findings of the study, one of the key factors of transforming our universities into reputable universities is leadership. In the context of the new environment, we need leaders who can become global players

Smart Detection of Cardiovascular Disease Using Gradient Descent Optimization

The Internet of Medical Things (IoMT) is the networking of health things or equipment that communicate data over the internet without the need for human involvement in the healthcare field. A large quantity of data is collected from numerous sensors in the health field, and it is all transferred and stored on the cloud. This data is growing bigger here all time, and it's becoming increasingly challenging to secure it on the cloud with real-time storage and computing. Data security problem can be addressed with the aid of machine algorithms and fog computing. For data security in IoMT gadgets correspondence in an intelligent fashion, an intelligent encryption algorithm (IEA) is proposed using blockchain technology in cloud based system framework (CBSF). It is applied on patient’s database to provide immutable security, tampering prevention and transaction transparency at the fog layer in IoMT.&nbsp; The suggested expert system's results indicate that it is suitable for use in for the security. In the fog model, the blockchain technology approach also helps to address latency, centralization, and scalability difficulties

Workplace learning and task performance: the moderating role of innovation and communication oriented culture

The Malaysian Public Service has taken diverse measures to reduce performance-related problems. The New Economic Model (NEM) was established in 2010 to strengthen the public sector in Malaysia in decision making and performance appraisal as well. It enhanced public sector performance and efficiency in service delivery and service quality. The purpose of this research was to investigate the strength level of the relationship between types of workplace learning and task performance in an innovation and communication-oriented culture. The relationship between three types of workplace learning, organizational culture and task performance were hypothesized to determine the moderating effect of communication and innovation orientation. These five hypotheses were supported. Interaction effect software was used to determine the power of relationship in the levels of a communication and innovation- oriented culture. The complementary role of these values was identified in the relationship between workplace learning and task performance

Global leadership in a university setting

What is global leadership? How can we develop global leadership for a university? This study was conducted using the qualitative approach through in-depth interviews of eight selected top leaders in a selected university. Based on the in-depth interviews, the findings discussed are as follows; Global leadership is related to diversity. Global leaders need to be developed with additional competencies to lead a university and to be able to compete worldwide. Global leadership has to operate in diverse situations. This means that a global leader has to understand different cultures, different ideas and different beliefs. So a global leader has to understand leading in diversity, which requires a different set of competencies. These include attitudes, skills and knowledge. This study is significant because it fills a gap in current knowledge regarding the experience that leaders perceived to be important in understanding and developing global leadership

The post-industrial landscape: pretty after ugly

As cities grow and compete to become more sustainable, their action is often to rectify mistakes of their unsustainable past. Remnants of industrial activity, brownfield sites provide opportunity where cities can undo the past and reinvent a greener future

Comparative histological and histochemical inter-species investigation of mammalian sub mandibular salivary glands

The major and accessory sub mandibular glands were obtained from different species of rodents belong to families Muridae (Meriones lybicus, Mus musculs, Cricetulus migraturus, Nesokia indica, Laboratory hamster and Apodemus sp.)? Dipodidae (Alactage elater and Jucullus blanfordi) and Sciuridae (Funambulus pennanti). The skulls of these species were separated immediately after death and fixed in buin with decalcification. Five um sections were stained with hematoxilen-eosin and tetrachrom. Periodic acid shiff and alcian blue (pH 1) were performed for sulfated natural mucins. Microscopic histological features, including existence of mucus and serous acini, presence of different kinds of tubules and different types of ducts as well as the histochemical characteristic features including histochemistry of different tubules and ducts in 2 different pH levels in the major and accessory sub mandibular glands in different rodents showed that the studied species proved to be different and the histological and histochemical study of sub mandibular salivary glands proved practicable with good discriminatory potential in evaluating the inter-species differences

USE OF COMPLEMENTARY/ALTERNATIVE MEDICINE (CAM) BY CANCER PATIENTS AT A UNIVERSITY HOSPITAL

Background and purpose: Complementary and alternative medicine (CAM) therapies are commonly used by cancer patients around the world. The aim of this cross-sectional study was to explore the extent of CAM therapies use by cancer patients, discover patients’ motives, sources, and beliefs regarding the benefits of CAM therapies, and determine patient awareness of possible adverse effects. Materials and methods: A comprehensive, validated questionnaire in Arabic was explained and given to patients who provided their consent to participate. All patients attended King Saud University-Medical City Oncology Center. Results: Among the patients, 136 responded to the questionnaire and 97 (71.3%) reported using some form of CAM therapies. The most frequently used CAM therapies were Zamzam water (Holy water from Makkah), honey, olive oil, black seeds, dates, and camel milk (with/without camel urine). Many patients were unaware of any adverse effects of CAM therapies. Statistical analyses showed that there were no significant differences between users and non-users in terms of gender, age, nationality, marital status, or educational level (p<.05). Conclusion: Many cancer patients use various forms of CAM therapies because they believe that CAM therapies may be beneficial and are harmless. Key Words: Complementary and alternative medicine, cancer, neoplasm, Saudi Arabia

Vacuolating encephalopathy and retinopathy associated with a nodavirus-like agent: a probable cause of mass mortality of wild Golden grey mullet (Liza aurata) and Sharpnose grey mullet (Liza saliens) in Iranian waters of the Caspian Sea

Mullets are dominant fishes in the catch composition in the southern coasts of the Caspian Sea and after (Rutilus frisii kutum Kamensky, 1901) have a worthy role in production of marine proteins and incomings of north provinces of Iran. Mullets stocks decreased dramatically in recent decades in the Caspian Sea and catch amount reached from 6446 MT on 2002 to 2151 MT in 2012. Mysterious mortalities occurred in wild mullet (Liza auratu) and (Liza saliens) in Iranian waters of Caspian Sea in recent years. Regarding to investigation of causative agent of mentioned outbreak about 322 suspected samples were collected from coastal capture sites of Iranian north provinces in 2008 till 2011. Moribund fish revealed skin darkening, erratic swimming, belly-up at rest and high distension of swim bladder. Target tissues such as brain and eye were removed and then fixed for histopathology and TEM assay. Widespread and massive vacuolation were observed in brain, spinal cord, retina and optical nerve and intracytoplasmic vacuoles and virus particles in retina. So concerning to clinical signs, histopathological and TEM findings, it could be concluded that nodavirus-like agent could be probable cause of mass mortality of wild mullet in Iranian waters of the Caspian Sea

Healthy Lifestyle Among School of Quantitative Sciences Lecturers, Universiti Utara Malaysia (UUM)

The role of individual healthy behaviors like physical activity, nutrition and stress management on reduction of rate of disease mortality and morbidity is well known. The aim of this study is to determine healthy lifestyle in lecturers employed in School of Quantitative Sciences, University Utara Malaysia, in 2019. Materials and Methods: The participants of this cross-sectional study were 66 lecturers in School of Quantitative Sciences, selected via random sampling method. The data collection was performed using a questionnaire including demographic healthy lifestyle questions. Analysis of the data was performed through Software Statistical Analysis System Enterprise Guide (SAS EG) version 7.1. Results: The mean age of the subjects was 42.68 ± 1.37 years and, BMI mean was 24.13 ± 0.86. 92.42% of them were married and 7.58% also were single. Conclusion: According to the results, planning for lecturers in School of Quantitative Sciences for receiving information about healthy lifestyle on weight control and nutrition are important