Group-based behavioural intervention for smoking cessation: is it all in their heads?

In the studies used for the analyses, group counseling is defined as having a minimum of two group meetings, and follow-up of smoking status at least 6 months after the start of the program, with carbon monoxide (CO) validated cessation. Most programs used between six and eight sessions, with the first few sessions devoted to discussion of motivation for quitting, health benefits, and strategies for planning a quit attempt. Participants may also keep records of the number of cigarettes smoked and the triggers for smoking (self-monitoring). Part of the group process also includes discussion and sharing of experiences and problems (intra-treatment social support), as well as on ways to seek appropriate support from friends, colleagues and family (extra-treatment social support)

Pharmacist as the Living Martindale; Power of Knowledge on antiviral information to prevent further spread and prompt treatment of COVID-19 Patients

Explain life cycle of SARS-CoV-2 and potential drug targets. Discuss information regarding antivirals for Covid-19

Are physicians and clinical pharmacists aware and knowledgeable enough about inappropriate prescribing for elderly patients? Findings from Malaysia

Objectives To assess the knowledge of physicians and clinical pharmacists about inappropriate prescribing for elderly patients, their confidence in prescribing for elderly patients, and their perceptions of barriers to appropriate prescribing in this population. Methods A cross-sectional study using a validated 20-item questionnaire was conducted among physicians (n=78) and clinical pharmacists (n=45) working in the medical wards of two tertiary hospitals in Malaysia. Knowledge was assessed by six clinical vignettes which were developed based on Beers criteria and the STOPP/START criteria. Other domains of the study were investigated using a four-point or five-point Likert scale. Results Of the 82 participants who completed the questionnaire, 65% were physicians, 90.2% had never received training in geriatric medicine, and 70.8% estimated that 25% or more of their patients were elderly. Only six participants (7.3%) had ever used STOPP/START or Beers criteria when prescribing for elderly patients, and 60% of the respondents had never heard of either one of those criteria. The mean score (SD) for the knowledge part was 3.65 (1.46) points, and only 27 participants (22.9%) scored more than four out of a possible six points. Overall, 34% of the participants rated themselves as confident in prescribing for elderly patients, and this was significantly associated with their knowledge score (P=0.02). The mean number (SD) of barriers cited per participant was 6.88 (2.84), with polypharmacy being the most cited barrier. Conclusions The majority of the participants had inadequate knowledge and low confidence regarding recommending medications for elderly patients. Continuing education on geriatric pharmacotherapy may be of value for the hospital physicians and pharmacists

Impact of pharmacist-to-prescriber educational intervention on statin therapy prescribing for type 2 diabetes mellitus patients in selected Malaysian primary care setting

Introduction: Previous research reported suboptimal prescribing of statin therapy for patients with type 2 diabetes mellitus (T2DM). There is a lack of data about the evaluation of impact of pharmacist-led interventions to improve statin therapy prescribing among T2DM population in Malaysia. Objectives: To evaluate the impact of pharmacist-to-prescriber educational intervention on enhancing the overall appropriate statin therapy prescribing among T2DM patients in selected Malaysian primary care settings. Materials and Methods: This was a quasi-experimental design involving a total of 816 medical records from four primary care clinics. The records were distributed as 412 from two sites subjected to study intervention and 404 from control study sites. The intervention was an academic detailing program offered to the general practitioners in two primary care clinics focusing on improving statin therapy prescribing. Post-intervention data collection was performed three months later. A comparison of the overall percentage of appropriate statin therapy prescribing before and after the intervention was performed in all study sites. Results: The assessment of the impact of pharmacist-to-prescriber educational intervention in the intervention study sites has revealed a statistically significant improvement in the appropriate statin prescribing from 63.2% (129/204) pre-intervention to 77.9% (162/208) post-intervention, p = 0.002. Moreover, the appropriate statin prescribing in control study sites was increased insignificantly from 71% (142/200) pre-intervention to 73.5% (150/204), p = 0.551. Conclusion: The pharmacist-to-prescriber educational intervention showed a positive impact on improving statin therapy prescribing among patients with T2DM in selected Malaysian primary care settings

Smoking cessation problem-based learning: Virtual experience

Background and Objectives: Problem-based learning (PBL) is a student-centered teaching and learning methodology where students collaboratively address specific issues. Tobacco use is a major health issue globally. Health professions and students need to have knowledge and skills to facilitate smoking cessation. The objective of this study is to assess feasibility of PBL during a virtual attachment involving institutions from Malaysia and the USA. Methods: A 4-week smoking cessation virtual attachment was conducted for three third-year University of Pittsburgh, USA pharmacy students. Malaysian smoking cessation experts designed and facilitated a PBL smoking cessation module. It was split into two 2-hour sessions with 3 triggers; Trigger 1: ‘Chief Presentation’, Trigger 2: ‘History & Motivational Interview’, and Trigger 3: ‘Brief 5A’s Intervention’. Students received Trigger 1 a day earlier and discussed amongst themselves. In session 1, Triggers 1-3 were given sequentially and discussed after completing all tasks from each trigger. In session 2 one-week later, facilitators gave formative assessment and students provided reflection regarding the PBL session. Upon completing the four-week virtual attachment, students provided feedback and facilitators graded the students. Result and Discussion: A comprehensive and interactive PBL session was successfully conducted virtually. Based on the clinical practice guidelines of both countries, there were differences in terms of availability and use of cessation medications, but the general principles of smoking cessation consultation and interventions were similar. Students were able to discuss the case openly, putting forth ideas and questions in both sessions. All students provided positive feedbacks regarding the PBL. Conclusions: With the extensive development of online platforms connecting the world over, student virtual attachment and mobility programmes can be easily conducted with minimal cost. A suitable module embedding PBL can be designed and conducted to best suit the online platform and the intended students

Tobacco control education in pharmacy : from theory to practice.

Tobacco smoking is recognized as a major cause of preventable diseases and premature deaths worldwide. It is estimated that more than five million smokers die annually due to smoking related diseases globally (WHO, 2008), The death toll is expected to escalate to more than eight million deaths annually by 2030 if the current smoking patterns continue (Peto et aI., 1994). Almost half of the long-term smokers die of a smoking-related disease (Doll et aI., 1994). In Malaysia, about 10,000 Malaysians die every year from smoking attributable diseases, mainly cardiovascular, cancer and stroke (Ministry ofHealth, 2003)

Smoking cessation problem-based learning: Virtual experience

Background and Objectives: Problem-based learning (PBL) is a student-centered teaching and learning methodology where students collaboratively address specific issues. Tobacco use is a major health issue globally. Health professions and students need to have knowledge and skills to facilitate smoking cessation. The objective of this study is to assess feasibility of PBL during a virtual attachment involving institutions from Malaysia and the USA. Methods: A 4-week smoking cessation virtual attachment was conducted for three third-year University of Pittsburgh, USA pharmacy students. Malaysian smoking cessation experts designed and facilitated a PBL smoking cessation module. It was split into two 2-hour sessions with 3 triggers; Trigger 1: ‘Chief Presentation’, Trigger 2: ‘History & Motivational Interview’, and Trigger 3: ‘Brief 5A’s Intervention’. Students received Trigger 1 a day earlier and discussed amongst themselves. In session 1, Triggers 1-3 were given sequentially and discussed after completing all tasks from each trigger. In session 2 one-week later, facilitators gave formative assessment and students provided reflection regarding the PBL session. Upon completing the four-week virtual attachment, students provided feedback and facilitators graded the students. Result and Discussion: A comprehensive and interactive PBL session was successfully conducted virtually. Based on the clinical practice guidelines of both countries, there were differences in terms of availability and use of cessation medications, but the general principles of smoking cessation consultation and interventions were similar. Students were able to discuss the case openly, putting forth ideas and questions in both sessions. All students provided positive feedbacks regarding the PBL. Conclusions: With the extensive development of online platforms connecting the world over, student virtual attachment and mobility programmes can be easily conducted with minimal cost. A suitable module embedding PBL can be designed and conducted to best suit the online platform and the intended students

Evaluating effectiveness and safety toward electronic cigarette among Malaysian vapers: One-month observational study

Objective: Electronic cigarette (e‑cig) is recently growing substitute for smoking. The attention and practice of e‑cig among consumers is expanded globally, and Malaysia is not an exception to this, but the paucity of local data motivates us to do the current research. Methods: A total of 220 e‑cig vapers recruited for the study and divided into two categories based on smoking status as a single user and dual user. Both users observed for 1 month period to assess smoking cessation rate, adverse effects, withdrawal symptoms, and smoking‑related diseases. Results: A month follow‑up showed still 28.44% (P ≤ 0.001) of the entire study population (62 of 218, intention to treat analysis) were abstained from tobacco smoking. However, a high number of single user shown more quit rate as compared to of dual users (72.9% [51] vs. 7.4% [11]: Odds ratio 33.43; 95% confidence interval: 0.102–3.410) and merely two persons (<1%) started e‑cig by ever smokers. The key adverse effects and withdrawal symptoms that observed in dual users were coughing, breathing problems, and craving, whereas in single users high appetite cases documented; however, no cases of any diseases reported among both users during the whole study period. Conclusion: A month follow‑up showed a good smoking cessation rate among Malaysian vapers mainly in single users, whereas less number of quitters but the high reduction in tobacco cigarette consumption observed in dual users without any harmful effects. Furthermore, extended period studies are warranted to confirm its long‑term safety and effectiveness among different Malaysian population

Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community

Purpose: To compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) on admission and discharge of patients, and to determine the associated predictors. Methods: This was a prospective observational study conducted in the multidisciplinary medical and surgical units of Hospital Tengku Ampuan Afzan (HTAA), Malaysia. The medications of patients who had been admitted to the hospital from community-dwelling settings were reviewed to identify PIMs/PPOs using version 2 of STOPP/START criteria. A logistic regression model was applied to detect the risk factors associated with PIM or PPO at discharge. Results: Among the 300 patients involved in the study, the prevalence of PIMs was 27 % upon admission, which decreased to 22.3 % at discharge (p = 0.014) with PIMs pertaining to increasing the risk of physical falls in elderly people being the most common for pre- and post-hospitalization. The prevalence of PPOs was 47.6 % upon admission, which increased to 48 % at discharge (p = 0.99), with the omission of musculoskeletal medications being the most common PPOs at admission and discharge. Having a PIM at discharge was associated with the number of discharge medications and the history of falls, whereas having a high comorbidity index score or history of falls was associated with having a PPO at discharge. Conclusion: Hospitalization significantly reduces the prevalence of PIMs, but not PPOs or polypharmacy, among elderly patients. The number of discharge medications and the history of falls are predictors of discharge PIM, whilst high comorbidities and the history of falls were the predictors of discharge PPO. Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy is required to optimize prescribing in elderly patients during hospitalization