Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia.

BACKGROUND: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities. OBJECTIVE: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique. METHODS: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule. RESULTS: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005). CONCLUSIONS: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.

Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia

Background: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities. Objective: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique. Methods: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule. Results: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005). Conclusions: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care (AU)

Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study.

OBJECTIVE: This study aimed to understand the dispensing practice of antibiotics in community pharmacy in Iraq, in addition to explore the community pharmacists' perception about dispensing antibiotics without prescription. METHODS: A qualitative design was conducted on community pharmacists in Baghdad, Iraq. Pharmacists were selected conveniently from different gender, age group, pharmacy type and years of experience. Face-to-face semi-structure interview was used with all the pharmacists to get in-depth understanding about their dispensing practice of antibiotics without prescription in community pharmacy. The data was coded and classified for thematic analysis. RESULTS: This study found that dispensing of antibiotics without prescription was a common practice in community pharmacy. Pharmacists' perception towards dispensing antibiotics without prescription was associated with the medical condition, safety and efficacy of antibiotics, patients request antibiotics by name, emergency cases, regular customer, promotions from pharmaceutical companies, saving time and cost, brand medications, and poor healthcare services. In addition, there were inadequate knowledge about antibiotic resistance and lack of awareness about antibiotic stewardship leading to inappropriate dispensing practice. CONCLUSIONS: Community pharmacists have poor perception towards dispensing antibiotics without prescription. Educational interventions about antibiotics use focusing on community pharmacists are needed. This will help to optimize the practice of dispensing of antibiotics in the community. In addition, training programs about antibiotic resistance are important to enhance pharmacists' understanding about antibiotic stewardship.

The Development and Validation of Quality of Life Scale for Iraqi Patients with Type 2 Diabetes Mellitus.

BACKGROUND AND AIM: The current trend for determining the effectiveness of new treatment or services provided for diabetes mellitus (DM) patients is based on assessing the improvement in both glycemic control and the patient quality of life. Many scales have been developed to assess quality of life among DM patients, but unfortunately, no one can be considered as gold standard. Therefore, this study aimed to develop and validate a brief and specific scale to assess quality of life among Iraqi type 2 DM patients. METHODS: An extensive literature review was done using Google-Scholar and PubMed to find out scales that utilized to assess quality of life among DM patients. Four relevant scales, three diabetes specific and one general, were selected. The selected scales were carefully evaluated to find out domains that are commonly used to assess quality of life and then the items within the selected domains were reviewed to choose relevant and comprehensive items for Iraqi type 2 DM patients. Ten items were selected to formulate the quality of life scale for Iraqi DM patients (QOLSID). The content validity of QOLSID was established via an expert panel. For concurrent validity QOLSID was compared to glycosylated hemoglobin (HbA1C). For psychometric evaluation, a cross sectional study for 103 type 2 DM patients was conducted at the National Diabetes Center, Iraq. Test-retest reliability was measured by re-administering QOLSID to 20 patients 2-4 weeks later. RESULTS: The internal consistency of the QOLSID was 0.727. All items had a corrected total-item correlation above 0.2. There was a negative significant correlation between QOLSID score and the HbA1C level (-0.518, P = 0.000). A significant positive correlation was obtained after re-testing (0.967, P = 0.000). CONCLUSION: The QOLSID is a reliable and valid instrument that can be used for assessing quality of life among Iraqi type 2 DM patients.

A comprehensive view of knowledge and osteoporosis status among type 2 diabetes mellitus in Malaysia: A cross sectional study

BACKGROUND: osteoporosis and diabetes mellitus are highly prevalent diseases that have potentially devastating effects on health and socioeconomic status. OBJECTIVE: The aims of this study were to assess: 1) the level of osteoporosis knowledge among T2DM patients; 2) the correlation, associations or differences of demographic characteristics, diabetes-related variable, as well as, lipid and blood pressure profiles with osteoporosis knowledge; and 3) the correlation between T-score measurement using quantitative ultrasound scan (QUS) and osteoporosis knowledge. METHODS: A cross-sectional study design was chosen, where data was collected using a self-report structured questionnaire using osteoporosis knowledge - Malay version questionnaire (OKT-M) among T2DM patients. Furthermore, the clinical data regarding the patients were collected retrospectively from the hospital medical record after patient interview was completed. RESULTS: The average age of the patients was 62.67 (SD 9.24) years (ranged from 33 to 87 years). Males (231, 51.30%) slightly outnumbered females. Among the racial distribution, the proportion of Chinese patients (204, 45.30%) was higher than Malay (127, 28.20%) and Indian patients (119, 26.40%). In addition, more than three quarters (343, 76.20%) of patients had poor glycaemic control. The average OKT-M total score, OKT-M Exercise subscale and OKT-M Calcium subscale were 12.55 (SD 4.06), 8.60 (SD 2.89) and 8.40 (SD 3.36), respectively. Only 33.30% of the T2DM patients were found to have high level of osteoporosis knowledge. There was a lack of identification and recognition of osteoporosis risk factors. There were significant differences or associations between osteoporosis knowledge and education level, monthly income, employment status, family history of fracture, smoking habit, alcoholic status, insulin use, therapy type and diastolic blood pressure. In addition, significant and positive correlations were found between T-scores and OKT-M total score (n=450, rs= 0.244, p = 0.000), OKT-M Exercise subscale (n=450, rs= 0.219, p = 0.000) and OKT-M Calcium subscale (n=450, rs=0.199, p = 0.000) among T2DM patients (all Ps<0.05). CONCLUSIONS: Overall, the study results showed a valuable insight into the knowledge toward osteoporosis, as well as its relation to the bone loss among T2DM patients. It is important to understand the basics of osteoporosis prevention behaviours such as adequate calcium intake and regular exercise which are essential to build and maintain healthy bones throughout life among T2DM

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Impact of Ramadan Focused Education Program on medications adjustment for patients with type 2 diabetes in a primary health care institution in Saudi Arabia.

AIMS: To examine the impact of Ramadan Focused Education Program (RFEP) on medications adjustment in type 2 diabetes patients in Ramadan. METHODS: This is a controlled, intervention based study. It was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n = 140) received RFEP on medications doses & timing adjustment before and after Ramadan, while the control group (n = 122) received standard care. RESULTS: The dose of insulin glargine was reduced from 42.51 ±â€¯22.16 at the baseline to 40.11 ±â€¯18.51-units during Ramadan (p = 0.002) in the intervention group while it remained the same in the control group before Ramadan and during Ramadan (38.51 ±â€¯18.63 and 38.14 ±â€¯18.46, P = 0.428, respectively). The hypoglycemia score was 14.2 ± (8.5) pre-Ramadan in the intervention and reduced to 6.36 ±â€¯6.17 during Ramadan (p < 0.001) while in the control group, no significant changes were noted before and during Ramadan (14.01 ±â€¯5.10 versus 13.46 ±â€¯5.30). CONCLUSIONS: Ramadan Focused Education Program done at a primary healthcare setting had a positive impact on medication adjustment for dose and timing during fasting in Ramadan in diabetic patients, and it can be a useful tool to achieve better outcomes; less hypoglycemia and safe fasting among T2D patients during Ramadan.

A comprehensive view of knowledge and osteoporosis status among type 2 diabetes mellitus in Malaysia: A cross sectional study.

BACKGROUND: osteoporosis and diabetes mellitus are highly prevalent diseases that have potentially devastating effects on health and socioeconomic status. OBJECTIVE: The aims of this study were to assess: 1) the level of osteoporosis knowledge among T2DM patients; 2) the correlation, associations or differences of demographic characteristics, diabetes-related variable, as well as, lipid and blood pressure profiles with osteoporosis knowledge; and 3) the correlation between T-score measurement using quantitative ultrasound scan (QUS) and osteoporosis knowledge. METHODS: A cross-sectional study design was chosen, where data was collected using a self-report structured questionnaire using osteoporosis knowledge - Malay version questionnaire (OKT-M) among T2DM patients. Furthermore, the clinical data regarding the patients were collected retrospectively from the hospital medical record after patient interview was completed. RESULTS: The average age of the patients was 62.67 (SD 9.24) years (ranged from 33 to 87 years). Males (231, 51.30%) slightly outnumbered females. Among the racial distribution, the proportion of Chinese patients (204, 45.30%) was higher than Malay (127, 28.20%) and Indian patients (119, 26.40%). In addition, more than three quarters (343, 76.20%) of patients had poor glycaemic control. The average OKT-M total score, OKT-M Exercise subscale and OKT-M Calcium subscale were 12.55 (SD 4.06), 8.60 (SD 2.89) and 8.40 (SD 3.36), respectively. Only 33.30% of the T2DM patients were found to have high level of osteoporosis knowledge. There was a lack of identification and recognition of osteoporosis risk factors. There were significant differences or associations between osteoporosis knowledge and education level, monthly income, employment status, family history of fracture, smoking habit, alcoholic status, insulin use, therapy type and diastolic blood pressure. In addition, significant and positive correlations were found between T-scores and OKT-M total score (n=450, rs= 0.244, P=0.000), OKT-M Exercise subscale (n=450, rs= 0.219, P=0.000) and OKT-M Calcium subscale (n=450, rs=0.199, P=0.000) among T2DM patients (all Ps<0.05). CONCLUSIONS: Overall, the study results showed a valuable insight into the knowledge toward osteoporosis, as well as its relation to the bone loss among T2DM patients. It is important to understand the basics of osteoporosis prevention behaviours such as adequate calcium intake and regular exercise which are essential to build and maintain healthy bones throughout life among T2DM.

Community pharmacists' perceptions towards online health information in Kuala Lumpur, Malaysia.

OBJECTIVE: The current study was carried out to assess community pharmacists' perceptions towards online health information, to examine the type of information seek from Internet and to identify the barriers when they retrieved online health information. METHODS: The study was designed as a cross-sectional questionnaire-based survey whereby all (300) community pharmacists practicing in Federal Territory of Kuala Lumpur, Malaysia were targeted for data collection. A 35-itemed questionnaire was posted out along with a stamped addressed envelope, invitation letter and support letter. Responses were also accepted via online response. Both descriptive and inferential statistics were used for data analysis. All statistical analysis was performed using SPSS v. 20.0. RESULTS: A total of 67 responses were received with a response rate of 22.3%. The top three frequently health information searched by respondents were medicine information, general healthcare information and disease-related information. High number of respondents agreed that Internet had too much health information to scan through. Gender (p=0.018) showed significant association with visiting established health websites. Meanwhile, statistical significant was observed between age and searching medicine information (p=0.037), undertaking online continuing professional development (p=0.023), as well as searching clinical guidelines (p=0.047). Respondents' education level showed significant association with uncertainty about the reliability of online health information (p=0.023) and unsure about filtering the information (p=0.007). CONCLUSIONS: Majority of the respondents expressed positive perception with the use of Internet for health information. The findings of the current study showed the widely use of Internet for health information among community pharmacists. Hence, this study provides opportunity for future works to further examine community pharmacist's retrieval and appraisal skills for online health information, as well as application of this information into their daily pharmacy practice.

Community pharmacists' perceptions towards online health information in Kuala Lumpur, Malaysia

Objective: The current study was carried out to assess community pharmacists' perceptions towards online health information, to examine the type of information seek from Internet and to identify the barriers when they retrieved online health information. Methods: The study was designed as a cross-sectional questionnaire-based survey whereby all (300) community pharmacists practicing in Federal Territory of Kuala Lumpur, Malaysia were targeted for data collection. A 35-itemed questionnaire was posted out along with a stamped addressed envelope, invitation letter and support letter. Responses were also accepted via online response. Both descriptive and inferential statistics were used for data analysis. All statistical analysis was performed using SPSS v. 20.0. Results: A total of 67 responses were received with a response rate of 22.3%. The top three frequently health information searched by respondents were medicine information, general healthcare information and disease-related information. High number of respondents agreed that Internet had too much health information to scan through. Gender (p=0.018) showed significant association with visiting established health websites. Meanwhile, statistical significant was observed between age and searching medicine information (p=0.037), undertaking online continuing professional development (p=0.023), as well as searching clinical guidelines (p=0.047). Respondents' education level showed significant association with uncertainty about the reliability of online health information (p=0.023) and unsure about filtering the information (p=0.007). Conclusions Majority of the respondents expressed positive perception with the use of Internet for health information. The findings of the current study showed the widely use of Internet for health information among community pharmacists. Hence, this study provides opportunity for future works to further examine community pharmacist's retrieval and appraisal skills for online health information, as well as application of this information into their daily pharmacy practice

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Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article.

Hypoglycemia is an essential issue for diabetic patients and considered a limiting factor in the glycemic management. Heterogeneity of the diseases in Type 2 Diabetes Mellitus can affect the frequency of hypoglycemia, especially when the patient has cardiovascular diseases. There are several factors that lead to hypoglycemia including sulfonylurea therapy, insulin therapy, delaying or missing a meal, physical exercise, or alcohol consumption. Long-term studies reported that repeated hypoglycemia could increase the risk of cardiovascular diseases. During Ramadan fasting, diabetic patients have high incidence of hypoglycemia. Therefore, focused education about hypoglycemia in routine life of diabetic patients and during fasting in Ramadan is important to reduce the complications.

Assessment of self-reporting reading of medicine's labels and the resources of information about medicines in general public in Malaysia.

This study was undertaken to assess the people's self-reported reading of medicine labels and its associated factors and to assess the sources of information about medicines among general public. A cross-sectional study was carried out among general public in the State of Penang, Malaysia. A total of 888 participants were conveniently selected and completed the survey. A self-administered questionnaire was used to obtain the data from all the participants. Most of the participants (74.2%) reported that they have adequate information about medicines provided on their medicine labels. In addition, 86.9% of them reported that they read their medicine's label for the directions of usage and 84.3% for the dosage instruction. However, 42.1% of the participants do not read their medicine's label for the active ingredients, and 33% of them do not read their medicine's label for the safety information. In addition, 36.5% of the respondents did not read the label of medicine for the symptoms which can be used for. However, females, Malay respondents, and higher education level (college/university) were more likely to self-reported the reading medicine's label. Females were more likely to read the labels of medicines compared with males (OR = 1.6, 95% CI 1.20-2.13, P = .001). The reading of medicine labels was predicted by females, Malay respondents, and higher educated people. Health educational programs are needed to clarify label's information that can help in concept of patient safety.

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia.

BACKGROUND: Patients' behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. OBJECTIVES: This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. METHODS: A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. RESULTS: This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. CONCLUSION: Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems.

Challenges in the management of community pharmacies in Malaysia.

BACKGROUND: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. OBJECTIVE: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. METHODS: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. RESULTS: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers' knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. CONCLUSION: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials.

Assessment of attitudes and practices of young Malaysian adults about antibiotics use: a cross-sectional study.

OBJECTIVE: The present study was aimed to evaluate the practices and attitudes of young Malaysian adults towards the use of antibiotics, and to determine the socioeconomic factors associated with the antibiotic use. METHODS: A survey was carried in Cheras community by approaching a conveniently selected sample of 480 participants. A pre-tested questionnaire was used for data collection. RESULT: Of 480 participants approached, 400 agreed to participate in this study, giving a response rate of 83.3%. The study results showed that 42.75% of the participants exhibited poor attitudes towards antibiotic usage. Chinese race and high income were significantly associated with the positive attitudes towards antibiotic usage. It is shown that the practice of the participants towards antibiotics was relatively poor. The majority of participants agreed that they do not consult a doctor for minor illnesses (64%). The main reason for not consulting a doctor was the high fees of consultation (34.25%) and the inconvenience of visit (29.25%). However, a large proportion of respondents (77.5%) agreed that there is a need to enhance antibiotic education among public. CONCLUSION: The study results identified some crucial gaps in the attitudes and practices of Cheras community about the use of antibiotics. Thus, improving the public knowledge and changing their attitude towards antibiotic use along with proper interventions to regulate the ease of their availability would play a significant role for the effective use of antibiotics in the community.

Assessment of attitudes and practices of young Malaysian adults about antibiotics use: a cross-sectional study

Objective: The present study was aimed to evaluate the practices and attitudes of young Malaysian adults towards the use of antibiotics, and to determine the socioeconomic factors associated with the antibiotic use. Methods: A survey was carried in Cheras community by approaching a conveniently selected sample of 480 participants. A pre-tested questionnaire was used for data collection. Result: Of 480 participants approached, 400 agreed to participate in this study, giving a response rate of 83.3%. The study results showed that 42.75% of the participants exhibited poor attitudes towards antibiotic usage. Chinese race and high income were significantly associated with the positive attitudes towards antibiotic usage. It is shown that the practice of the participants towards antibiotics was relatively poor. The majority of participants agreed that they do not consult a doctor for minor illnesses (64%). The main reason for not consulting a doctor was the high fees of consultation (34.25%) and the inconvenience of visit (29.25%). However, a large proportion of respondents (77.5%) agreed that there is a need to enhance antibiotic education among public. Conclusion: The study results identified some crucial gaps in the attitudes and practices of Cheras community about the use of antibiotics. Thus, improving the public knowledge and changing their attitude towards antibiotic use along with proper interventions to regulate the ease of their availability would play a significant role for the effective use of antibiotics in the community (AU)

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Challenges in the management of community pharmacies in Malaysia

Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials (AU)

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Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah, Saudi Arabia - a matched case-control study.

Objective To determine risk factors for multi-drug-resistant Acinetobacter baumannii (MDR-AB) nosocomial infections in intensive care units in a tertiary care hospital, Makkah, Saudi Arabia. Methods We performed a hospital-based, matched case-control study in patients who were admitted to Al Noor Specialist Hospital between 1 January 2012 and 31 August 2012. The study included cases of A. baumannii nosocomial infection and controls without infection. Controls were matched to cases by age and ward of admission. Results The most frequent site of infection was the respiratory tract (77.3%). Susceptibility to antimicrobial MDR-AB was 92.0% for ceftazidime and ciprofloxacin, while it was 83.3% for imipenem, 83.0% for trimethoprim, 79.0% for amikacin, and 72.7% for gentamicin. Multiple logistic regression of risk factors showed that immunosuppression (OR = 2.9; 95% CI 1.5-5.6; p = 0.002), clinical outcome (OR = 0.4; 95% CI 0.3-0.9; p = 0.01), invasive procedures (OR = 7.9; 95% CI 1.8-34.2; p = 0.002), a central venous catheter (OR = 2.9; 95% CI 1.5-5.6; p = 0.000), and an endotracheal tube (OR = 3.4; 95% CI 1.6-7.3; p = 0.001) were associated with MDR-AB. Conclusions Acinetobacter nosocomial infections are associated with admission to the ICU (Intensive care unit) and exposure to invasive procedures.

A qualitative exploration of hypertensive patients' perception towards quality use of medication and hypertension management at the community level.

OBJECTIVE: This study aimed to explore hypertensive patients' perspectives on quality use of medication and issues related to hypertension management at the community level in Malaysia. METHODS: Focus groups discussion was employed in this qualitative study. A total of 17 hypertensive patients were purposively recruited. Three focus group discussions with semi-structured interview were carried out at Flat Desa Wawasan, Penang. All the conversations were audio recorded, transcribed verbatim and thematically analysed. RESULTS: Three major themes were developed, including medication adherence among hypertensive patients, self-management of hypertension and patients' knowledge towards hypertension. Poor medication adherence was found and different strategies were taken to overcome the barriers towards adherence. Use of herbal and traditional therapies was perceived as alternative method in controlling blood pressure instead of taking antihypertensive medication. The participants were found to have poor knowledge on side effect and mechanism of action of hypertensive medication. CONCLUSIONS: The misconception about the side effect of antihypertensive medication has led to poor adherence among the participants. Lack of knowledge on targeted blood pressure level has led to poor blood pressure monitoring among the participants. Health awareness program and counselling from health care professional should be advocated among the hypertensive patients in addressing the above gaps.

Assessment of knowledge and perceptions toward generic medicines among basic science undergraduate medical students at Aruba.

OBJECTIVE: Use of generic medicines is important to reduce rising health-care costs. Proper knowledge and perception of medical students and doctors toward generic medicines are important. Xavier University School of Medicine in Aruba admits students from the United States, Canada, and other countries to the undergraduate medical (MD) program. The present study was conducted to study the knowledge and perception about generic medicines among basic science MD students. MATERIALS AND METHODS: The cross-sectional study was conducted among first to fifth semester students during February 2015. A previously developed instrument was used. Basic demographic information was collected. Respondent's agreement with a set of statements was noted using a Likert-type scale. The calculated total score was compared among subgroups of respondents. One sample Kolmogorov-Smirnov test was used to study the normality of distribution, Independent samples t-test to compare the total score for dichotomous variables, and analysis of variance for others were used for statistical analysis. RESULTS: Fifty-six of the 85 students (65.8%) participated. Around 55% of respondents were between 20 and 25 years of age and of American nationality. Only three respondents (5.3%) provided the correct value of the regulatory bioequivalence limits. The mean total score was 43.41 (maximum 60). There was no significant difference in scores among subgroups. CONCLUSIONS: There was a significant knowledge gap with regard to the regulatory bioequivalence limits for generic medicines. Respondents' level of knowledge about other aspects of generic medicines was good but could be improved. Studies among clinical students in the institution and in other Caribbean medical schools are required. Deficiencies were noted and we have strengthened learning about generic medicines during the basic science years.

Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists' perceptions.

BACKGROUND: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used. OBJECTIVE: To identify potential areas to improve the existing labels used for pediatric liquid medications. METHODS: This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach. RESULTS: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions. CONCLUSION: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.