Student's perception on case based learning implementation and foreign lecturer participation in medium classroom

Teacher based-learning is commonly practiced in Indonesian Universities. However, this conventional method is lacking in preparing students with required skills such as a problem solving skill. Equipping students with this skill is one of the aims of higher education provider and is also parallel with the implementation of Asian Economic Community that opens the market to all graduates from Southeast Asian countries to compete globally. Thus, the approach of teaching needs to be redesigned from teacher based-learning to case based-learning which able to prepare students with such a skill. This study evaluated the perception of year four pharmacy students from University Islam Indonesia on case based-learning. A total of 233 students included in the study and they were divided into two groups. The first group of students (119 students) were taught by a foreign lecturer while the second group by an internal lecturer. All students received same patient case studies which were obtained from Indonesian and Malaysian hospitals. Students were given a standard form with step by step guides for them to solve the case study. The guides included identification and assessment of drug related problems (DRP) as well as recommendation and monitoring of the DRP. The lecturer was a facilitator who led a discussion and provided feedback on the case study. The perception on the implementation of case based learning was assessed using the perception questionnaire which were distributed to all students at the end of semester. The results showed that majority of students agreed on the implementation of case based learning. A foreign lecturer has a good impact on motivating students to improve their English language

Productivity losses and its associated factors among end stage renal disease patients receiving dialysis treatment in Kuantan, Pahang

Introduction: In Malaysia, the economic burden of end stage renal disease (ESRD) patients receiving haemodialysis (HD) and peritoneal dialysis (PD) treatment, in terms of productivity loss from the societal perspectives, is unknown. Thus, this study intended to investigate the extent of productivity losses of these patients and factors associated with productivity losses. Methodology: A multi-centre, cross-sectional study was conducted between September 2019 and February 2020 in Kuantan, Pahang. Time loss due to dialysis treatment was measured among working-age ESRD patients and was multiplied with the gross national income for the year 2020 to estimate productivity losses. Factors associated with productivity loss was determined using multivariate regression analyses. Results: Among 284 working-age ESRD patients receiving dialysis treatment, 27.8% (n=79) were in paid employment while 48.9% (n=139) were on unpaid work. The productivity loss of HD patients was significantly higher than that of PD patients (MYR 11,968.93 versus MYR 7,214.92 per patient-year, p<0.05). The annual productivity losses at the local level were MYR2.34 million, and the estimated annual productivity losses at the state and national level were MYR12 million and MYR 234 million, respectively. HD treatment, post-dialysis side effects, post-dialysis recovery period and iron administration were significantly associated with a higher productivity loss (p<0.05). Conclusion: This study applauds the national strategic policy to increase PD uptake for eligible ESRD patients because PD led to a lower productivity loss compared to HD. Additionally, a proper clinical management policy for anaemic patients and patients suffering from post-dialysis side effects requiring post-dialysis recovery may improve productivity for ESRD patients

Sex differences in high opioid dose escalation among Malaysian patients with long term opioid therapy

Purpose: This study evaluated the risk of opioid dose escalation as it relates to sex differences among patients receiving opioids for long-term therapy. Patients and methods: This retrospective cohort study was conducted in tertiary hospital settings in Malaysia using electronic prescription records. Opioid naïve patients, aged ≥ 18 years, who were undergoing long-term opioid therapy of ≥ 90 days, with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1st January 2011 and 31st December 2016, were included in the study. They were followed until (i) the end of the study period, (ii) death from any cause or (iii) discontinuation of therapy from their first opioid prescription without any intervals of ≥ 120 days between successive prescriptions. The risk of high opioid dose escalation to ≥ 100 mg/day and ≥ 200 mg/day relative to men and women was measured. Results: A total of 4688 patients (58.8% women, 41.3% men) on long-term opioid therapy were identified. Among these patients, 248 (5.29%) were escalated to high opioid doses of ≥ 100 mg/day and 69 (1.47%) were escalated to ≥ 200 mg/day. The escalation to high-dose opioid therapy was more likely to occur in men than in women, even after adjustment for age (dose ≥ 100 mg/day [adjusted hazard ratio 2.32; 95% confidence interval (CI), 1.79 to 3.00; p < 0.0001] and ≥ 200 mg/day [adjusted hazard ratio 6.10; 95% CI, 3.39 to 10.98; p < 0.0001]). Conclusion: The risk of opioid dose escalation differed between men and women, as men were at higher risk than women for high opioid dose escalation

Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; a Delphi study

1.1 Background The general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care. 1.2 Method This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response. 1.3 Results Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed. 1.4 Conclusion Overall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysi

Drug utilization and drug pricing in the private primary healthcare system in Malaysia: an employer price control mechanism

Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all 38 analyses were performed using Stata v15.1 There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the 41 study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine.(6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400% and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients 48 being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment

Prescription-level of tramadol utilisation at a tertiary hospital setting in Malaysia: changing trends over a 7-year follow-up period

INTRODUCTION It was reported in a previous study that tramadol was the most frequently prescribed analgesic in Malaysia’s hospital outpatient setting. However, little is known of its trends of prescribing. OBJECTIVES This study evaluated the trends of tramadol prescribing in Malaysia. METHOD This retrospective cross-sectional study was conducted using the prescription database of a tertiary hospital in Malaysia. All tramadol prescriptions in outpatient setting issued for adult patients aged ≥18 years old from 2010 to 2016 were included. The annual number of prescriptions and patients measured in repeat cross-sectional estimates for each year were evaluated. Descriptive statistics and linear trend analysis were applied using Stata version 15.1. RESULTS A total of 64594 tramadol prescriptions were prescribed for 40965 patients from 2010 to 2016. Prescriptions for tramadol increased by 52.7% from 7643 in 2010 to 11763 in 2016, with an average annual increment of 7.1%. The number of new patients prescribed with tramadol increased gradually throughout the study period (a 7.2% increase annually) with the majority (75.6%, n=30974) of them receiving one tramadol prescription. CONCLUSION: Tramadol prescribing increased gradually over a 7-year study period, with the majority of patients receiving only one prescription of tramadol - most likely indicating the use of tramadol for acute pain conditions. Further investigation on the indication and its clinical outcomes are required to ensure safe and rational use of tramadol

Self-medication with antibiotics: prevalence, practices and related factors among the Pakistani public

Abstract: Self-medication with antibiotics (SMA) has become considerably common in developing countries, which is a critical factor for driving antibiotic resistance. Individuals involved in SMA generally do not have adequate knowledge regarding the appropriate use, indications and dosage of these drugs. The objective of the present study was to investigate population SMA practices, knowledge and sociodemographic factors associated with SMA in Islamabad, Pakistan. The study adopted a cross-sectional methodology and data collection was performed through an anonymous, structured and pilot-tested questionnaire, which was interview-administered. Inferential statistics and multivariate logistic regression were performed. Out of 480 participants, 55.6% (n = 267) were male with a mean age of 37.1 � 10.1 years; the total prevalence of SMA was 32.5%. Ciprofloxacin (42.9%) was the most commonly used antibiotic to treat coughs or colds, a runny nose, flu or sore throat, diarrhea or fevers, which were relevant reasons for SMA. Findings from multivariate logistic regression showed that predictors of SMA were: male gender (95%CI: 0.383–1.005), age (95%CI: 0.317–0.953) and highest level of education (95%CI: 0.961–0.649). Despite reasonable access to healthcare facilities, people are still obtaining antibiotics without prescription, bypassing diagnostic and consultative healthcare services. Thus, the government must implement strict healthcare policies to restrict the sale of antibiotics without prescriptions, while at the same time, targeted public awareness campaigns about the proper use of antibiotics are also require

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Patient characteristics and risk factors contributing to disease progression among hospitalised patients with Covid-19: lesson from Malaysia

Background: Patients who were hospitalised with severe COVID-19 infection could progress to severe conditions due to various factors, whereas some patients may recover to mild conditions quickly. There was limited information regarding characteristics and factors affecting disease progression in this population in Malaysia. This study aimed to investigate patient characteristics and risk factors contributing to disease progression among COVID-19 patients during hospitalisation. Methods: A retrospective cross-sectional study using electronic medical record data from COVID-19 patients admitted to two public hospitals in East Coast Malaysia from February 2020 to August 2021 was conducted. This study included patients with asymptomatic or mild condition (stage 1 – stage 3) upon hospital admission and progressed to severe condition (stage 4 – stage 5) during hospitalisation. Results: A total of 163 patients were included (57% male) with the age of (mean±SD, 62.3 ±14.0 years). Multivariable logistic regression associated with COVID-19 disease progression included elderly (OR, 1.06; 95% CI, 1.04, 1.08; p = ≤0.05), diabetes mellitus (OR, 2.27; 95% CI, 1.27, 4.06; p = 0.006), chronic kidney disease (OR, 4.87; 95% CI, 1.92, 12.38; p=0.001), and presented with more than three COVID-19 symptoms (OR, 9.80; 95% CI, 6.08-15.81, p = ≤0.05). Conclusion: Risk factors for COVID-19 disease progression included elderly patients, comorbidities of diabetes mellitus, chronic kidney disease or more than three COVID-19 symptoms. Close monitoring and early intervention should be implemented for these patients to prevent the disease progression and poor prognosis

Differential patterns of adherence to opioid therapy in opioid naïve and opioid existing patients with different age groups

Limited data are available on the adherence to opioid therapy and the influence of different patient groups on adherence. This study examined the patterns of adherence in opioid naïve and opioid existing patients with varying age and gender. This retrospective cohort study was conducted using the prescription databases in tertiary hospital settings in Malaysia from 2010 to 2016. Adult patients aged ≥18 years, receiving at least two opioid prescriptions, were included and stratified into the opioid naïve and existing patient groups. Adherence to opioid therapy was measured using the proportion of days covered (PDC), which was derived by dividing the total number of days covered with any opioids by the number of days in the follow-up period. Generalized linear modeling was used to assess factors associated with PDC. A total of 10,569 patients with 36,650 prescription episodes were included in the study. Of these, 91.7% (n = 9,696) were opioid naïve patients and 8.3% (n = 873) were opioid existing patients. The median PDC was 35.5% (interquartile range (IQR) 10.3–78.7%) and 26.8% (IQR 8.8–69.5%) for opioid naïve and opioid existing patients, respectively. A higher opioid daily dose (coefficient 0.010, confidence interval (CI) 0.009, 0.012 p < 0.0001) and increasing age (coefficient 0.002, CI 0.001, 0.003 p < 0.0001) were associated with higher levels of PDC, while lower PDC values were associated with male subjects (coefficient −0.0041, CI −0.072, −0.010 p = 0.009) and existing opioid patients (coefficient −0.134, CI −0.191, −0.077 p < 0.0001). The suboptimal adherence to opioid medications was commonly observed among patients with non-cancer pain, and the opioid existing patients were less adherent compared to opioid naïve patients. Increasing age and a higher daily opioid dose were factors associated with higher levels of adherence, while male and opioid existing patients were potential determinants for lower levels of adherence to opioid medications