Assessment of awareness, knowledge, attitude, and the practice of vitamin D among the general public in Malaysia

Introduction: Vitamin D deficiency is becoming a global epidemic, which is still undertreated despite increased treatment availability and increase in therapeutic options. This study aimed to explore the awareness, knowledge, attitude and practices regarding Vitamin D among the general public in Malaysia. Methods: A cross-sectional survey was carried out in a public area using a convenience sampling technique to recruit participants around Selangor and Kuala Lumpur shopping malls area. An anonymous self-administered questionnaire was used for data collection and it was circulated to 603 Malaysian. A total of 400 participants were completed and returned to the researchers.   Result: Although 90.5% of the participants have heard/learnt about Vitamin D. About 78.0% of them showed limited knowledge about some aspects of Vitamin D with (mean ± SD = 1.78 ± 0.894). Additionally, there was a negative attitude towards Vitamin D and sunlight exposure. For instance, nearly 70.0% of the respondents did not like to expose themselves to sunlight.  Only 30.0% of the participants had taken Vitamin D supplement before. There is a small, positive correlation between the knowledge score and education level, rho = 0.124, n = 400, P = 0.013, with a higher score associated with higher education level. Conclusion: The findings provided a piece of contemporary real-world evidence on the lack of knowledge and practices about Vitamin D among the general public. Therefore, extensive health educational campaigns for the public should be implemented by the government to raise their knowledge on the importance of Vitamin D. Keywords: knowledge; practice; vitamin D; public; Malaysia DOI: https://doi.org/10.3126/jkahs.v2i3.2664

Health-related quality of life as a predictor of tuberculosis treatment outcomes in Iraq

Summary ObjectivesTo determine how tuberculosis (TB) treatment affects the health-related quality of life (HRQL) of patients with pulmonary TB and to identify the predictors of favourable TB treatment outcomes in Baghdad, Iraq. MethodsThe Functional Assessment of Chronic Illness Therapy – Tuberculosis (FACIT-TB), a new TB-specific quality of life instrument derived from the internationally recognized FACIT measurement system for the assessment of HRQL, was administered. The mean total and subscale scores of the FACIT-TB at baseline, end of the intensive phase, and end of TB treatment were compared. ResultsAfter the 2-month intensive phase, physical well-being, functional well-being, and the overall total scores were significantly increased (p<0.01). Furthermore, at completion of TB treatment, there were significant improvements in the overall HRQL as indicated by the FACIT-TB total score and all subscales, except social and economic well-being and spiritual well-being. In a direct logistic regression model, only the FACIT-TB total score made a statistically significant contribution towards predicting the likelihood that a patient would have a favourable TB treatment outcome. ConclusionsTherapeutic intervention had a positive impact on patient HRQL. We conclude that FACIT-TB is a reliable tool to monitor HRQL during the course of TB treatment.Universiti Sains Malaysia, Research University Postgraduate Research Grant Scheme (USM-RU-PRGS; grant number 1001/PFARMASI/845040)

What is “Opioid Stewardship”?:An Overview of Current Definitions and Proposal for a Universally Acceptable Definition

Introduction: Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear. Objective: To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition. Methods: Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice. Results: After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of “opioids stewardship”. A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making. Conclusion: Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients

Attitude, Familiarity and Religious Beliefs about Vaccination among Health Science and Non-Health Science Students in a Malaysian Public University

Abstract Vaccine hesitancy has surfaced globally within the last few decades, and the fears and misconceptions of people about vaccine safety and effectiveness have been identified as key factors for their under-utilization. The familiarity, attitudes, and religious beliefs of the public and of future healthcare practitioners regarding vaccination are extensive areas needing exploration. The present exploratory cross-sectional study was designed, planned and carried out on students enrolled in health science and non-health science courses in one of the public universities of Malaysia. A research instrument that had been formulated, validated and subjected to reliability testing was used to collect the data, which were analyzed using descriptive and inferential statistics. A response rate of 80.8% (n = 202) was obtained: the majority were female (n = 161, 79.7%), and had been vaccinated before (n = 190, 97.5%), while a mere 2% did not support vaccination for reasons pertaining to safety issues. The vaccine familiarity score was 10.79 ± 1.4, which significantly differed among the study disciplines (p < 0.001). The mean of the total attitude score was 14.95 ± 1.5, with no significant difference among demographics being noted. The mean of the total religious beliefs score was 24.29 ± 2.8 and significantly differed based on gender (p = 0.040) and study disciplines (p < 0.001). The current findings showed that the participants were familiar with vaccines and had generally positive attitudes and positive religious beliefs toward vaccination; thus, one can expect that their inclusion in immunization campaigns will generate positive outcomes of the immunization program. Although the current research reported few knowledge gaps, these may be handled with the introduction of a specialized immunization course at an undergraduate level

Exploring the Capability of the Hospital Pharmacists in Conducting Pharmacy Practice Research: A Study from Malaysia

The engagement of pharmacists in research activities is pivotal in the advancement of the pharmacy practice. The study aims to evaluate the confidence and competence of Malaysian hospital pharmacists in conducting clinical and practice-based research. A cross-sectional study was carried out between September 2019 and April 2020 using an online survey. Pharmacists from eight different hospitals in Malaysia were involved in the study. The survey link was sent to all pharmacists of the included hospitals via email. Data were analysed using SPSS version 25. A total of 226 pharmacists participated in this study, and their average age was 28 years old. About 82 % of the participants reported that they did not have any previous research experience, and around 62% of them indicated that the research training during their undergraduate study was inadequate. At least 60% of the participants reported inadequate competence and/or confidence in developing research protocols, critically appraising the literature, undertaking and applying appropriate statistical techniques, and interpreting research findings. There is an urgent need to reinforce undergraduate and postgraduate research training in the institutions among potential and current pharmacists to build competence in research techniques such as literature reviews and scholarly participation

Medication use problems and factors affecting older adults in primary healthcare

Background: As the largest demographic group utilizing primary healthcare facilities, older adults often face the challenge of managing multiple chronic illnesses, leading to numerous medications. Objective: The present study aims to assess medication use problems among older adults and explore the factors affecting them in primary healthcare settings. Methods: A mixed-method study was conducted to establish a baseline understanding of the perspectives and challenges faced by older adults, with regards to medication use. Translated Medication Use Questionnaire (MedUseQ), a patient-centered tool, was distributed to older adults above 60 in primary healthcare settings to assess their frequency of problems related to medication use. Fifteen semi-structured interviews were conducted to explore this topic in depth. Descriptive and inferential analyses were conducted with quantitative data. Interviews were transcribed verbatim, and thematic analysis was conducted. Quantitative and qualitative findings data were triangulated. Results: The study involved 393 participants. The most common problems with regards to medication use were polypharmacy (55.4%), administration difficulties (48.4%), limited awareness about adverse drug events (47.3%), issues with adherence (46.5%), and accessibility to primary healthcare (42.7%). Approximately 55% were satisfied with the older adult-centered medication use services by pharmacist and doctors. The qualitative findings showed that major factors affecting medication use were forgetfulness, language barriers, lack of awareness, transportation problems, long waiting times, and multiple visits to healthcare facilities. Conclusion: The findings of this study reveal that a significant proportion, around 50%, of the older adult population face challenges with medication use in Penang. These difficulties mainly stem from medication administration, adherence, accessibility, polypharmacy, and inadequate medication knowledge. The qualitative analysis further highlighted several factors that contribute to such medication-related problems. Given the rapidly aging Association of Southeast Asian Nations (ASEAN) population, it is essential to devise effective solutions and strategies to tackle medication use-related issues among older adults.We would like to thank all the participants who have contributed to this study.Scopu

Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients : a systematic review

Background: Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists’ services on the ECHO of patients in South Asian countries. Methods: We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists’ services, from both hospital and community settings, were included. Results: The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle. Conclusion: This systematic review suggests that pharmacists have essential roles in improving patients’ ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated

Pharmacist Involvement in Cancer Pain Management: A Systematic Review and Meta-Analysis

This review aimed to critically evaluate the impact of pharmacist involvement in managing pain in cancer patients. Databases (including MEDLINE, Embase and CENTRAL) were searched with a broad search strategy for studies involving pharmacists and cancer pain management until February 10, 2021. The quality of studies and evidence were assessed using standardized tools and GRADE, respectively. A random-effects model was used for meta-analysis. Sixty-four studies were included. Common interventions delivered by the pharmacists were medication review, patient education, adverse drug reactions (ADRs) detection and management, pharmacological recommendations (in dosing and pharmacotherapy choice), and pain assessment. A pooled analysis of 3 randomized control trials showed a significant reduction in pain intensity with a standardized mean difference (SMD) of 0.35 [95% confidence intervals (CI): -0.55, -0.16]. Pooled analyses from nonrandomized studies of interventions also showed significant results in reduction of ADRs with an odds ratio of 0.69 (95% CI: 0.61, 0.79) and improvement in quality of life with SMD of 0.80 (95% CI: 0.29, 1.32). Thus, pharmacists significantly improve the clinical outcomes of cancer patients related to pain. This indicates the involvement of pharmacists directly or in collaboration with healthcare professionals in the oncology team is highly beneficial for the patients. Perspectives: This systematic review presents a comprehensive evaluation of pharmacist involvement in cancer pain management. This shows the importance of direct involvement of the pharmacist or as an important member of the multidisciplinary oncology team

The impact of clinical pharmacist services on patient health outcomes in Pakistan:a systematic review

Abstract Background The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes. Methods We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. Results The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. Conclusions The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed