Systemic Clinical Manifestations and Treatment of Granulomatosis with Polyangiitis: A Case Report

Granulomatosis with polyangiitis (GPA) is a granulomatous disorder linked with systemic necrotizing vasculitis with varied initial manifestations. We describe a case of a 49-year-old Malay female patient who gradually developed more symptoms of GPA over the past 14 years. This case emphasizes early detection and optimal treatment to minimize any further complications of GPA

Readiness and willingness of Malaysian community pharmacists in providing vaccination services

Background: Vaccination is an efective public health intervention in reducing morbidity and mortality of infectious diseases. Compared to other countries where community pharmacists (CPs) administer vaccines, CPs in Malaysia are not authorised. This study aimed to assess CPs’ readiness and willingness to provide vaccination in Malaysia, identify potential barriers to and factors supporting the provision of this service. Methods: A cross-sectional study was conducted among Malaysian CPs from April to June 2021. A validated online questionnaire was distributed through social media, instant messaging, email, and pharmacy societies. Results: Of 492 CPs recruited throughout Malaysia, 439 (89.2%) expressed willingness to provide vaccination services to the public, 403 (81.9%) agreed with the accessibility of community pharmacies to the public, and 73.4% agreed that their role in vaccination could help to improve the overall vaccination coverage rate. The lack of pharmacist training in vaccination and concerns on maintaining patient safety were identifed as barriers to CPs’ implementation of vaccination services, with 52.8% and 47.8% of them agreeing, respectively. Training sessions and operational guidelines on providing vaccination services are required to overcome the barriers. Conclusion: CPs in Malaysia were ready and willing to provide vaccination services to the public. However, the implementation demands training workshops and re-evaluation of CPs in public vaccination programmes by Malaysian healthcare policymakers

A fuzzy rule-based expert system for asthma severity identification in emergency department

The emergency department (ED) of a hospital is an important unit that deals with time-sensitive and life-threatening medical cases. Rapid treatment and accuracy in diagnosis are considered the main characteristics of excellent operational processes in ED. However, in reality, long waiting time and uncertainty in the diagnosis has affected the quality of ED services. Nonetheless, these problems can be improved by utilising computing technologies that assist medical professionals to make fast and accurate decisions. This paper investigates the issues of under-treatment and uncertainty condition of acute asthma cases in ED. A novel approach, known as the fuzzy logic principle is employed to determine the severity of acute asthma. The fuzzy set theory, known as Fuzzy Rule-based Expert System for Asthma Severity (FRESAS) determination is embedded into the expert system (ES) to assess the severity of asthma among patients in ED. The proposed fuzzy methodology effectively manages the fuzziness of the patient’s information data, and determines the subjective judgment of medical practitioners’ level on eight criteria assessed in severity determination. Knowledge acquisition and representation, fuzzification, fuzzy inference engine, and defuzzification are the processes tested by the FRESAS development that incorporates expert advice. The system evaluation is performed by using datasets that were extracted from the ED clerking notes from one of the hospitals in Northern Peninsular Malaysia.System evaluation demonstrates that the proposed system performs efficiently in determining the severity of acute asthma. Furthermore, the proposed system offers opportunities for further research on other types of diseases in ED, and improves other hybridisation approaches

Regional Differences In Household Expenditure On Pharmaceuticals: Evidence From Malaysia

This study investigates the factors associated with pharmaceutical expenditure share (PES) among households in different regions of Malaysia. Using data from the Household Expenditure Surveys 2014 and 2016, the study found that on average, a Malaysian household had a PES of 0.8%, which was equivalent to Ringgit Malaysia (RM) 30-40 per month. In general, households with younger, male, less-educated, or Bumiputera heads were less likely to consume pharmaceutical products and had lesser PES than others. Not owning insurance reduced the likelihood of consuming pharmaceutical products and PES. Urban households in low- and middle-income states had a higher PES than rural households. This study recommends more public health clinics in urban areas of low- and middle-income states and townships with more elderly in order to improve access to essential medicines

A Green Fuzzy Multi-Criteria Decision Making Model for Pharmaceutical Waste Disposal Management

Pharmaceutical waste known as hazardous substances should be disposed of in the best possible manner to avoid harm toward public health and the environment. Hence, designing a green decision-making model for pharmaceutical waste disposal management is needed at this point. To achieve the objective, this research intended to investigate the criteria, sub-criteria and disposal treatments that incorporate the green practice for disposing of pharmaceutical waste. This research also aimed to find the importance weights of criteria and sub-criteria, which later are adopted to rank the disposal treatments. In addition, the sensitivity analysis is also proposed to be conducted. By using a systematic literature review and experts’ opinions that involved the policymakers from the Ministry of Health Malaysia, a comprehensive list of criteria, sub-criteria and disposal treatments are successfully collected. To compute the importance weights and rank the disposal treatments for pharmaceutical waste, the data is collected from the respondents who are actively involved in the waste management fields, which include the Ministry Health of Malaysia, Kualiti Alam Sdn Bhd, Radicare (M) Sdn Bhd, Medivest Sdn Bhd and academician from Higher Education Institution. A set of questionnaires is used as a medium of data collection and Fuzzy Delphi TOPSIS (FDT) is employed to analyze data from the questionnaire. By considering the importance weights of economic, environmental, social and technical criteria, the results revealed that waste immobilization (encapsulation) is ranked as the best disposal treatment, which is followed by incineration, secured landfill and chemical disinfection. Next, the sensitivity analysis is conducted according to the eight scenarios to evaluate and check the influence of different importance weights toward the final model. Findings from the sensitivity analysis indicated that the final model is robust and can be implemented in Malaysia’s current pharmaceutical waste disposal management

Predictors of Treatment Response in Patients with Treatment-Resistant Depression: Outcomes of a Randomized Trial

Objective: This report aims to compare the effectiveness between electroconvulsive therapy (ECT) and transcranial direct stimulation (tDCS) among patients with treatment-resistant depression (TRD) and the associated factors. Methods: This was a secondary data analysis of a randomized, controlled, open-label trial conducted from 1 July 2018, to 31 December 2018. The dataset of 90 patients included in the study was retrieved from Mendeley Data. Patients with TRD were randomized 1:1 into either receiving ECT or tDCS. A good treatment response was determined as an improvement from the Hamilton Depression (HAM-D) baseline score at a rate of more than or equal to 50% at the end of a 2-week intervention. A mixed-effect logistic regression was performed to explain the hierarchical data structure of predictors to successful treatment outcome. Results: The largest magnitude of change was consistently observed in the ECT treatment arm across both HAM-D score and the clinical global impression severity scale (CGI-S) scale (p < 0.001). Lower baseline HAM-D scores (OR: 0.72, 95% CI: 0.58, 0.92), lower baseline CGI-S scale (OR: 0.30, 95% CI: 0.17, 0.55), and ECT as the choice of treatment modality (OR: 14.0, 95% CI: 5.08, 38.58) independently predicted successful therapy among TRD patients, while modelling with multiple logistic regression determined that low socio-economic status (aOR: 20.01, 95% CI: 1.89, 211.47), ECT (aOR: 31.7, 95% CI: 6.32, 159.0) and a lower baseline CGI-S scale (aOR: 0.18, 95% CI: 0.06, 0.57) were significantly predictive of a positive treatment outcome among patients with TRD. Conclusions: ECT was more effective in alleviating depressive symptoms in TRD as compared to tDCS

Healthcare professionals’ experiences on interdisciplinary collaboration in a medical department of a Malaysian general hospital

Healthcare professionals (HCPs) in all healthcare facilities including public hospitals in Malaysia need to cooperate to meet the diverse healthcare demands. To date, there has yet detailed research on this collaboration in Malaysia. This study aimed to explore interdisciplinary collaboration in the Medical Department (wards and clinics) of a state hospital. Four focus group discussions (FGDs) were held. A medical specialist, medical officer, nurse manager/charge nurse, staff nurse, senior and junior clinical pharmacists were all present at each FGD. Purposive sampling was used to recruit participants (nomination by heads of department). FGDs were performed in English, but responses in Malay were accepted and translated into English. All FGDs were audio-recorded, transcribed, and analysed thematically. In the theme of role clarity, most participants opined that the doctors led in patient management, while the nurses were in charge of monitoring, ambulating and drug administration. However, some participants were unfamiliar with the role of pharmacists. The majority believed that effective collaboration did exist, but insufficient. Weak communication skills, lack of communication, personnel and time were obstacles to effective collaboration. Regular discussions between different disciplines can encourage interprofessional collaboration. Despite doctors acknowledging pharmacists' Medication Therapy Adherence Clinic (MTAC) services, and nurses' human immunodeficiency virus (HIV) counselling and diabetic education services, some nurses and pharmacists were unaware of each other's services. To avoid conflicting tasks and human resource wastage, each HCP's services should be actively promoted among other HCPs

Compliance of Community Pharmacists and Private General Medical Practitioners With Malaysian Laws on Poisons and Sale of Drugs

Background: Compliance of community pharmacists (CPs) and private general medical practitioners (GPs) with Malaysian Laws on Poisons and Sale of Drugs is crucial in encouraging rational supply of medicine to patients that will subsequently lead to rational use of medicine, especially controlled medicine and psychotropic substances. This study aims to identify the trend of yearly compliance rate of both CPs and GPs with the Malaysian Laws on Poisons and Sale of Drugs, and to quantify the effectiveness of disciplinary actions in improving their compliance level. Methods: This is a retrospective observation study from the Sarawak state Pharmaceutical Enforcement Division (PED) inspection reports on CPs and GPs from January 1, 2012, to December 31, 2014. Descriptive statistics in numbers and percentages are used to present the results. Results: From years 2012 to 2014, the compliance rate of GPs increased from 34% to 51%, while the compliance rate of CPs remained almost constant, with a slight drop from 53% (2012) to 50% (2014). The most common noncompliance found among CPs is with the Poison Acts 1952 Section 26 Condition 2: “Records for the supply of preparations containing Pseudoephedrine, Ephedrine and Dextromethorphan,” and among GPs, it is the Regulation 12 of Poisons Regulation 1952: “labeling of dispensed medicines.” Warning letter is the most effective disciplinary action for both CPs (75% improvement) and GPs (67.8% improvement). Conclusion: This study serves as a baseline that provides valuable insights to policy makers, researchers, and other stakeholders in developing better enforcement strategies. © 2017, ©The Author(s) 2016