Public perception towards landscape of conflict: a preliminary study on historic battlefield preservation in Malaysia

Landscapes of conflict in Malaysia are currently under constant threats from the urbanization process and often permanently lose its historical characteristics. Besides the need for appropriate legislation to protect this type of cultural resources, public understanding, and awareness regarding the battlefield landscape’s importance may also contribute towards its future existence. This study employed an on-site questionnaire survey to identify the public perception of the historic battlefield landscape. A total of 60 respondents participated in the survey conducted at the Muzium Tentera Darat (Army Museum) in Port Dickson. The survey offers positive insights into the level of public awareness, essential elements, and design recommendations for future battlefield landscape preservation. The study also revealed that religious and mystical phenomena typically associated with deadly spaces are not public issues

Evaluation of anti-hypertensive drug utilisation and cost in Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure. Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions

A national audit on the utilization and documentation of dabigatran checklist for patients initiated on dabigatran

Background: Direct oral anticoagulants (DOACs) especially dabigatran, have gain popularity for their efficacy, fixed dosing and favourable safety profile. A dabigatran prescribing checklist has been prepared by the Ministry of Health, Malaysia (MOH) to ensure rational and safe prescribing of dabigatran. This study therefore aimed to audit the utilization and documentation of this checklist and use of dabigatran in the government healthcare facilities. Methods: This is a nationwide retrospective audit on the documentation of Dabigatran Prescribing and Dispensing Checklist for a period of two years from January 2013 till December 2014. Data from these Dabigatran Checklists (indication, dose, duration, renal function and adverse drug reactions encountered) were extracted by the pharmacist at MOH healthcare facilities. Results: A total of 52 out of 56 (92.9%) of MOH facilities complied to usage of checklist at their centres involving a total of 582 patients of which 569 (97.7%) patients were initiated on dabigatran for the approved indications. The recommended dose of dabigatran was used correctly in 501 (99.6%) of patients. Reason for switching to DOACs use was only documented in 76.7% (131/171) of patients. The most common reason for switching from warfarin was poor INR control (n=39), history of bleeding/overwarfarinisation (n=22) and unable to attend regular INR clinic (n=21). There were 75 cases of adverse events reported. The most common adverse event reported were abdominal discomfort (n=10) followed by gum bleeding (n=9) and dizziness (n=5). Conclusions: Compliance to the dabigatran check list was high with 70% of patients prescribed the appropriate dosing

Assessing adherence and persistence to non-vitamin k antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG). Materials and Methods: This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence. Result: There were 281 patients who met the inclusion criteria, with 54.1% (n = 152) male. There were 75.1% (n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% (n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% (n = 196) were persistence with >60-day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence. Conclusion: Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving the

Assessing adherence to direct oral anticoagulants (DOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

INTRODUCTION Direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence to DOACs in real-life clinical practice in Malaysia are scarce. OBJECTIVES This study aimed to assess adherence to DOACs in patients with AF at Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG), tertiary-care referral centers. METHODOLOGY This was a retrospective cohort study that included all AF patients who were treated with DOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy database. Adherence was assessed by using proportion of days covered (PDC) over a 1-year duration and was calculated as the number of days that the medication was on hand over the total number of days in the time period. Good adherence was defined as PDC ≥80% RESULTS There were 281 patients who met the inclusion criteria, male 54.1% (n=152), with 75.1% (n=211) patients on dabigatran and others on rivaroxaban. The ethnic distribution was Chinese 49.8% (n=140), Malay 41.6% (n=117), and Indian 8.5% (n=24). Only 66.9% of patients achieved good adherence with PDC ≥ 80%. Adherence by institution was good in HKL with 85.2% (n=69/81) but poor in HSDG with 59.5% (n=119/200) [p<0.05]. CONCLUSION Overall adherence to DOACs was poor but it varied between institutions, potentially due to institution-specific administrative and clinical practice differences. Clinical care can potentially be optimized by identifying factors affecting adherence and implementing adherence-improving interventions

Parallel algorithms on some numerical techniques using PVM platform on a cluster of workstations

In this paper, a few parallel algorithms are explained in solving one dimensional heat model problem using Parallel Virtual Machine (PVM). This research focuses on two iteration methods, Iterative Alternating Decomposition Explicit Method (IADE) and Alternating Group Explicit Scheme (AGE). Conjugate Gradient (CG) is selected as an alternative method to accelerate the convergent and efficiency of these two iteration methods

Knowledge of Atrial Fibrillation and Stroke Prevention: Development of Questionnaire and Validation of Results

Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages

Knowledge of atrial fibrillation and stroke prevention: development of questionnaire and validation of results

Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages

Cost-effectiveness of anti-hypertensive medications in a regional hospital in rural Malaysia

Objectives: Hypertension is one of the most important risk factors for Cardiovascular Disease in Malaysia. Population-based hypertension control is extremely poor at only 6% based on the 1996 National Health and Morbidity Survey. One of the possible reasons include the availability and cost of antihypertensive medications. Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure. Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE-Inhibitors (33.45%), Calciumchannel blockers (29.63%), diuretics (16.67%), Beta blockers (13.64%) and Alpha blockers (2.69%). In terms of cost however, the Calcium-channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE-Inhibitors at just 20.04% of the annual expenditure. The most ‘cost-effective’ group of drugs are the diuretics making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The Calcium-channel blockers are the most ‘cost-ineffective’ medications available at our regional Hospital making up less than one third of the total annual prescriptions but making up nearly two-thirds of the annual anti-hypertensive budget. The most ‘cost-effective’ medications were diuretics, Beta-blockers and ACE-inhibitors in order of ‘cost-effectiveness’