Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia.

BACKGROUND: Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital. METHOD: This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records. RESULTS: There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19. CONCLUSION: Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.

Assessment of an intensive education program for pharmacists on treatment of tobacco use disorder using an objective structured clinical examination: a randomized controlled trial.

BACKGROUND: Tobacco use is one of the major public health threats globally. Community pharmacists are uniquely positioned to offer tobacco cessation services owing to their easy accessibility by the public. To prepare Qatar community pharmacists to develop the competencies and skills required to offer smoking cessation services, an intensive tobacco control education program was designed and implemented. The study aimed to assess the impact of the tobacco education program on the pharmacists' skills and competence. METHODS: A random sample of community pharmacists in Qatar was chosen for participation in the program. Consenting participants were randomly assigned to either intervention or control groups. The intervention group received an intensive education program on treatment of tobacco-use disorder, while a short didactic session on a non-tobacco-related topic was delivered to the control group. The pharmacists' tobacco cessation skills and competencies were assessed using an Objective Structured Clinical Examination (OSCE). RESULTS: A total of 54 and 32 community pharmacists in the intervention group and the control group, respectively, completed the OSCE. The intensive tobacco education group achieved significantly higher total scores than the control group in all the OSCE cases. Specifically, the mean total scores for the intervention group were 15.2, 15.3, 14.2, 14.6, 16.3, and 15.2 compared to 8.8, 6.2, 7.7, 9.2, 8.3, and 11.3 for the control group (p < 0.001) for cases one to six respectively. CONCLUSION: The study demonstrated that an intensive tobacco cessation education program can improve pharmacists' tobacco cessation skills and increase their tobacco cessation counseling abilities. TRIAL REGISTRATION: Clinical Trials NCT03518476 ( https://clinicaltrials.gov/ct2/show/NCT03518476 ) Registration date: May 8, 2018.

Evaluating Nicotine Abstinence, Smoking Cessation, Reduction and its Relapsed Among Electronic Cigarettes Single and Dual Malaysian Users: A One Year Observational Study.

PURPOSE: Evidence for the complete nicotine cessation is inadequate among electronic cigarettes (ECs) single users (SUs, use only ECs), and dual users (DUs, use both ECs and conventional cigarettes (CCs). The primary aim of this study was to evaluate the nicotine cessation among SUs and DUs who used ECs over one year. METHODS: We observed 70 SUs and 148 DUs for 52 weeks and tested their exhaled carbon monoxide and saliva cotinine to confirm their complete nicotine cessation status through cotinine in saliva. Safety issues were to be identified through self-report. Smoking cessation, CCs reduction of ≥ 50%, and relapsed to CCs smoking and safety issues were also documented. RESULTS: The nicotine cessation rate was higher in SUs then DUs (15.9% vs. 6.8%; P = 0.048; 95% CI (2.328-0.902). A similar result for smoking cessation (34.8% SUs vs. 17.1% DUs; P = 0.005; 95% CI: 2.031-0.787), whereas CCs ≥ 50% reduction was 23.3% DUs vs 21.7% SUs (P = 0.863; 95% CI :1.020-0.964). Relapse to CC smoking was 47.3% in DUs versus 30.4% in SUs (P = 0.026; 95% CI: 1.555-0.757). The adverse effects reported were coughing and breathing problems, whereas craving smoking was documented as a major withdrawal symptom. Smoking-related diseases were also identified, five in DUs and two in SUs, during the one-year study period. CONCLUSIONS: Study showed SUs achieved higher complete nicotine and smoking cessation rates as compared to DUs. However, the rates of reduced CC use were not different between both the groups. No serious adverse effects related to the sole use of ECs were detected. However, the safety of the sole use of ECs in absolute terms needs to be further validated in different populations.

Effectiveness of School-Based Smoking Prevention Education Program (SPEP) Among Nonsmoking Adolescents: A Quasi-Experimental Study.

Preventing smoking among adolescents is critical. This study evaluated the effectiveness of the Smoking Prevention Education Program among nonsmoking adolescents. A quasi-experimental study design was used. Data were collected from Year 5 students (n = 140) from four government primary schools in the Kuantan and Pahang districts of Malaysia. The participating schools were randomly assigned into the intervention and control groups. Questionnaires and exhaled carbon monoxide (CO) levels were used to collect data at the baseline and at 3 months postintervention. At 3 months postintervention, the percentage of nonsmokers remained 100% in the intervention group, while 2.9% of the participants in the control group reported to have smoked in past 7 days. Comparatively, the mean scores of attitudes, subjective norms, and nonsmoking intentions of the intervention group improved significantly. The intervention was effective in preventing smoking initiations among Malaysian adolescents; however, further evaluation of this intervention is needed among varied populations.

Does inappropriate prescribing affect elderly patients' quality of life? A study from a Malaysian tertiary hospital.

PURPOSE: To investigate the association between potentially inappropriate medication (PIM)/potential prescribing omission (PPO) and the health-related quality of life (HRQoL) among community-dwelling hospitalized elderly patients. METHODS: This is a cross-sectional study that took place in a Malaysian tertiary hospital. Patients ≥ 65 years old with at least one medication on admission were recruited. The patients' prehospitalization medications were reviewed to identify PIMs/PPOs using version 2 of the STOPP/START criteria. HRQoL was assessed using the EuroQol-5 dimensions (EQ-5D) and EuroQol-visual analog scale (EQ-VAS). The association between the presence of PIM/PPO and the patients' HRQoL was analyzed using Chi-square and Mann-Whitney U tests. Multiple linear regression models were applied to determine the effect of exposure to PIM/PPO on the patients' HRQoL, adjusting for confounders. RESULTS: Out of 517 patients who fulfilled the inclusion criteria, 502 patients (97%) accepted to be involved in the study and completed the HRQoL questionnaire. The mean (SD) age was 72.4 (5.9) years. 393 (78.3%) of the patients had problems in at least one EQ-5D dimension with pain/discomfort problem being the most reported complaint. The mean (SD) values of the EQ-5D index and the EQ-VAS were 0.734 (0.214) and 59.6 (14.2), respectively, which are lower than those seen in the general Malaysian population. PIM and PPO were found in 28.5% and 45.6% of the patients, respectively. No significant differences were found in the EQ-5D dimensions, EQ-5D index and EQ-VAS between patients who had PIM/PPO and those who did not. Age, sex, and comorbidities were significantly associated with the patients' HRQoL. CONCLUSION: PIM and PPO are not uncommon among hospitalized elderly patients; however, it does not significantly affect their HRQoL as measured by the EQ-5D-3L instrument.

Effectiveness and safety of electronic cigarettes among sole and dual user vapers in Kuantan and Pekan, Malaysia: a six-month observational study.

BACKGROUND: Current studies on electronic cigarettes (ECs) have assessed the smoking cessation effectiveness and safety of EC among sole EC users. However, in Malaysia and elsewhere, most EC users also smoke conventional cigarettes (CCs). We aimed to investigate nicotine cessation for both ECs and CCs. Additionally, safety issues among sole EC and dual (EC and CC) users over a six-month period were reported. METHODS: We observed 218 sole Malaysian EC and dual users over 6 months from June 2015 to November 2015. Both groups underwent exhaled breath carbon monoxide and saliva cotinine analyses to verify their nicotine cessation from both EC and CC use. Adverse events and withdrawal symptoms were assessed based on self-reports. RESULTS: Only 3.3% of observed users quit both ECs and CCs, whereas 20.5% quit smoking CCs. Quitting ECs and CCs was significantly higher among sole EC users (5 vs 2, respectively; OR: 5.62; P = 0.036) than it was among dual users, a result that was similar for CCs smoking (29 vs. 15; OR: 6.33; P ≤ 0.001). No severe health issues were reported over the entire study period. CONCLUSION: The rates of quitting CCs and ECs were higher in sole EC users than those in dual users. No serious health effects were reported over 6 months in either group. ECs may serve as a smoking cessation aid in Malaysia, but appropriate regulations are necessary to encourage sole EC use to ensure product quality. Large randomised clinical trials (RCTs) with a longer follow-up are required to better measure the effectiveness and safety of ECs use alone and in combination with CCs.

Visible light- and dark-driven degradation of palm oil mill effluent (POME) over g-C3N4 and photo-rechargeable WO3.

The investigations of real industrial wastewater, such as palm oil mill effluent (POME), as a recalcitrant pollutant remain a subject of global water pollution concern. Thus, this work introduced the preparation and modification of g-C3N4 and WO3 at optimum calcination temperature, where they were used as potent visible light-driven photocatalysts in the degradation of POME under visible light irradiation. Herein, g-C3N4-derived melamine and WO3 photocatalyst were obtained at different calcination temperatures in order to tune their light absorption ability and optoelectronics properties. Both photocatalysts were proven to have their distinct phases, crystallinity levels, and elements with increasing temperature, as demonstrated by the ultraviolet-visible spectroscopy (UV-Vis), X-ray diffraction analysis (XRD), thermogravimetric analysis (TGA), Fourier-transform infrared spectroscopy (FTIR), Brunauer-Emmett-Teller (BET), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS) results. Significantly, g-C3N4 (580 °C) and WO3 (450 °C) unitary photocatalysts exhibited the highest removal efficiency of POME without dilution due to good crystallinity, extended light absorption, high separation, and less recombination efficiency of electron-hole pairs. Furthermore, surprisingly, the superior energy storage photocatalytic performance with outstanding stability by WO3 achieved an approximately 10% increment during darkness, compared with g-C3N4 under visible light irradiation. Moreover, it has been proven that the WO3 and g-C3N4 photocatalysts are desirable photocatalysts for various pollutant degradations, with excellent visible-light utilization and favorable energy storage application.

Stages of change and health-related quality of life among employees of an institution.

BACKGROUND: Transtheoretical Model of change has been used successfully in promoting behaviour change. OBJECTIVE: To examine the relationships between health-related quality of life (HRQoL) scores with the stages of change of adequate physical activity and fruit and vegetables intake. DESIGN: This was a cross-sectional study conducted among employees of the main campus and Engineering campus of Universiti Sains Malaysia (USM) during October 2009 and March 2010. MAIN VARIABLES STUDIED: Data on physical activity and fruit and vegetable intake was collected using the WHO STEPS instrument for chronic disease risk factors surveillance. The Short Form-12 health survey (SF-12) was used to gather information on participants' HRQoL. The current stages of change are measured using the measures developed by the Pro-Change Behaviour Systems Incorporation. STATISTICAL ANALYSIS: One way ANOVA and its non-parametric equivalent Kruskal-Wallis were used to compare the differences between SF-12 scores with the stages of change. RESULTS: A total of 144 employees were included in this analysis. A large proportion of the participants reported inadequate fruits and vegetable intake (92.3%) and physical activity (84.6%). Mean physical and mental component scores of SF-12 were 50.39 (SD = 7.69) and 49.73 (SD = 8.64) respectively. Overall, there was no statistical significant difference in the SF-12 domains scores with regards to the stages of change for both the risk factors. CONCLUSIONS: There were some evidence of positive relationship between stages of change of physical activity and fruit and vegetable intake with SF-12 scores. Further studies need to be conducted to confirm this association.

Microtubular cellulose-derived kapok fibre as a solid electron donor for boosting photocatalytic H2O2 production over C-doped g-C3N4 hybrid complexation.

Cellulose continues to play an important and emerging role in photocatalysis, and its favourable properties, such as electron-rich hydroxyl groups, could enhance the performance of photocatalytic reactions. For the first time, this study exploited the kapok fibre with microtubular structure (t-KF) as a solid electron donor to enhance the photocatalytic activity of C-doped g-C3N4 (CCN) via ligand-to-metal-charge-transfer (LMCT) to improve hydrogen peroxide (H2O2) production performance. As confirmed by various characterisation techniques, the hybrid complex consisting of CCN grafted on t-KF was successfully developed in the presence of succinic acid (SA) as a cross-linker via a simple hydrothermal approach. The complexation formation between CCN and t-KF results in the CCN-SA/t-KF sample displaying a higher photocatalytic activity than pristine g-C3N4 to produce H2O2 under visible light irradiation. The enhanced physicochemical and optoelectronic properties of CCN-SA/t-KF imply that the LMCT mechanism is crucial in improving photocatalytic activity. This study promotes utilising the unique t-KF material's properties to develop a low-cost and high-performance cellulose-based LMCT photocatalyst.

TiO2 Nanotubes Decorated with Mo2C for Enhanced Photoelectrochemical Water-Splitting Properties.

The presence of Ti3+ in the structure of TiO2 nanotube arrays (NTs) has been shown to enhance the photoelectrochemical (PEC) water-splitting performance of these NTs, leading to improved results compared to pristine anatase TiO2 NTs. To further improve the properties related to PEC performance, we successfully produced TiO2 NTs using a two-step electrochemical anodization technique, followed by annealing at a temperature of 450 °C. Subsequently, Mo2C was decorated onto the NTs by dip coating them with precursors at varying concentrations and times. The presence of anatase TiO2 and Ti3O5 phases within the TiO2 NTs was confirmed through X-ray diffraction (XRD) analysis. The TiO2 NTs that were decorated with Mo2C demonstrated a photocurrent density of approximately 1.4 mA cm-2, a value that is approximately five times greater than the photocurrent density exhibited by the bare TiO2 NTs, which was approximately 0.21 mA cm-2. The observed increase in photocurrent density can be ascribed to the incorporation of Mo2C as a cocatalyst, which significantly enhances the photocatalytic characteristics of the TiO2 NTs. The successful deposition of Mo2C onto the TiO2 NTs was further corroborated by the characterization techniques utilized. The utilization of field emission scanning electron microscopy (FESEM) allowed for the observation of Mo2C particles on the surface of TiO2 NTs. To validate the composition and optical characteristics of the decorated NTs, X-ray photoelectron spectroscopy (XPS) and UV absorbance analysis were performed. This study introduces a potentially effective method for developing efficient photoelectrodes based on TiO2 for environmentally sustainable hydrogen production through the use of photoelectrochemical water-splitting devices. The utilization of Mo2C as a cocatalyst on TiO2 NTs presents opportunities for the advancement of effective and environmentally friendly photoelectrochemical (PEC) systems.

Enhancing the security of E-Health services in Bangladesh using blockchain technology.

The telemedicine service concept was mainly established to benefit the underprivileged people from rural areas of a country. However, due to the low literacy and awareness rates among rural population of Bangladesh, the service is not much effective. This paper represents a study on the awareness of the rural population of telemedicine service in Bangladesh and few key findings indicate how the awareness could be increased. The research also suggests that utilizing blockchain technology can enhance the data security and privacy. The research reveals some of the findings which can raise the awareness and popularity of telemedicine service among rural population. We have proposed implementation of blockchain technology which can vastly improve the security issue.

Readiness and willingness of Malaysian community pharmacists in providing vaccination services.

BACKGROUND: Vaccination is an effective 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 identified 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 new 10-D hyperchaotic system with coexisting attractors and high fractal dimension: Its dynamical analysis, synchronization and circuit design.

This work introduce a new high dimensional 10-D hyperchaotic system with high complexity and many of coexisting attractors. With the adjustment of its parameters and initial points, the novel system can generate periodic, quasi-periodic, chaotic, and hyperchaotic behaviours. For special values of parameters, we show that the proposed 10-D system has a very high Kaplan-Yorke fractal dimension, which can reach up to 9.067 indicating the very complexity of the 10-D system dynamics. In addition, the proposed system is shown to exhibit at least six varied attractors for the same values of parameters due to its multistability. Regions of multistability are identified by analysing the bifurcation diagrams of the proposed model versus its parameters and for six different values of initial points. Many of numerical plots are given to show the appearance of different dynamical behaviours and the existence of multiple coexisting attractors. The main problem with controlling chaos/hyperchaos systems is that they are not always fully synchronized. therefore, some powerful synchronization techniques should be considered. The synchronization between the high-dimensional 10-D system and a set of three low-dimensional chaotic and hyperchaotic systems is proposed. Ten control functions are designed using the active control method, ensuring synchronisation between the collection of systems and the 10-D hyperchaotic system. Finally, using Multisim 13.0 software to construct the new system's electronic circuit, the feasibility of the new system with its extremely complicated dynamics is verified. Therefore, the novel 10-D hyperchaotic system can be applied to different chaotic-based application due to its large dimension, complex dynamics, and simple circuit architecture.

Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis.

Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper-Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using I 2 and τ 2 statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4-77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25-42%) (I 2 = 100%, τ2 = 0.9170, p < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27-63%) (I 2 = 100%, τ2 = 1.0886, p < 0.01) than Europe (29%, 95% CI: 20-40%) (I 2 = 100%, τ2 = 0.7944, p < 0.01). Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071. Plain Language Summary: Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors?Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America's compared with European cohorts of PLWH.Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.

The Role of Media and Retailer Message Recall on Malaysian Male Perceptions of E-Cigarette Use: The 2016 National Study of E-Cigarettes Prevalence.

This study examined the perceptions of current smokers on electronic cigarette (EC) use, after exposure to information on EC use and its potential harms from various media and retail outlets. This cross-sectional study is a sub-analysis of the National Study of Electronic Cigarettes Prevalence (N = 4289) using the multi-stage stratified sampling method. Respondents were interviewed face-to-face by a trained data collector using a structured questionnaire printed in both Bahasa Malaysia and English. The analysis included 376 males who smoked conventional cigarettes and/or used ECs and reported ever seeing messages on ECs/vape in various platforms were analyzed using weighted simple and multiple logistic regression. Our findings showed different media types resulted in differing perceptions among smokers towards EC use especially between social media and conventional media. Those exposed to messages promoting EC in social media had higher odds of believing that ECs help people quit smoking (OR: 2.28), the urge to smoke is reduced by ECs (OR: 1.86), ECs are more effective than medication for quitting smoking (OR: 1.96), breathing is improved after using ECs (OR: 2.85), the smell of EC is better than a tobacco cigarette (OR: 2.73), and ECs should be regulated rather than banned completely (OR: 3.08). Vape shops, social, and conventional media provided very different perceptions among smokers towards EC use. Beyond using traditional communication channels, EC promoters have successfully utilized social media to promote ECs among smokers.

ASSOCIATION OF SMOKING AND SEVERITY OF COVID-19 INFECTION AMONG 5,889 PATIENTS IN MALAYSIA: A MULTI-CENTER OBSERVATIONAL STUDY.

OBJECTIVE: This study aims to investigate the association between smoking and the severity of COVID-19 infection during the initial wave of this pandemic in Malaysia. METHODS: This is a multi-center observational study using secondary hospital data collected retrospectively from February 1, 2020, until May 30, 2020. Clinical records of all real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases with smoking status, co-morbidities, clinical features, and disease management were retrieved. Severity was assessed by the presence of complications and outcomes of COVID-19 infection. Logistic regression was used to determine the association between COVID-19 disease severity and smoking status. RESULTS: A total of 5,889 COVID-19 cases were included in the analysis. Ever smokers had a higher risk of having COVID-19 complications, such as acute respiratory distress syndrome (odds ratio [OR] 1.69; 95% confidence interval [CI] 1.09-2.55), renal injury (OR 1.55; 95% CI 1.10-2.14), and acute liver injury (OR 1.33; 95% CI 1.01-1.74), compared with never smokers. However, in terms of disease outcomes, there were no differences between the two groups. CONCLUSION: Although no significant association was found in terms of disease outcomes, smoking is associated with a higher risk of having complications owing to COVID-19 infection.

Malaysian pharmacy students' perspectives on the virtual objective structured clinical examination during the coronavirus disease 2019 pandemic.

PURPOSE: This study investigated pharmacy students' perceptions of various aspects of virtual objective structured clinical examinations (vOSCEs) conducted during the coronavirus disease 2019 pandemic in Malaysia. METHODS: This cross-sectional study involved third- and fourth-year pharmacy students at the International Islamic University Malaysia. A validated self-administered questionnaire was distributed to students who had taken a vOSCE a week before. RESULTS: Out of the 253 students who were approached, 231 (91.3%) completed the questionnaire. More than 75% of the participants agreed that the instructions and preparations were clear and helpful in familiarizing them with the vOSCE flow. It was found that 53.2% of the respondents were satisfied with the flow and conduct of the vOSCE. However, only approximately one-third of the respondents believed that the tasks provided in the vOSCE were more convenient, less stressful, and easier to perform than those in the conventional OSCE. Furthermore, 49.7% of the students favored not having a vOSCE in the future when conducting a conventional OSCE becomes feasible again. Internet connection was reported as a problem hindering the performance of the vOSCE by 51.9% of the participants. Students who were interested in clinical pharmacy courses were more satisfied than other students with the preparation and operation of the vOSCE, the faculty support, and the allocated time. CONCLUSION: Students were satisfied with the organization and operation of the vOSCE. However, they still preferred the conventional OSCE over the vOSCE. These findings might indicate a further need to expose students to telehealthcare models.

BiFeO3 immobilized within liquid natural rubber-based hydrogel with enhanced adsorption-photocatalytic performance.

Semiconductor materials have shown a good photocatalytic behaviour for the photodegradation of organic pollutants. In this work, maleated liquid natural rubber (MLNR) based hydrogel supported bismuth ferrite (BiFeO3) as photocatalyst was successfully synthesized by crosslinking with acrylic acid (AAc) assisted by the ultrasonication method to study the efficiency for the removal of methylene blue (MB) dye in wastewater. Response surface methodology (RSM) was used to optimize the parameters for adsorption of the methylene blue (MB) dye compound, whereby the effects of the initial concentration of MB and the adsorption time were examined to obtain a quadratic model for the respective hydrogel composite. The prepared composite sample was characterized by Fourier Transform Infrared (FTIR) spectroscopy, Scanning Electron Microscopy-Energy Dispersive X-ray (SEM-EDX) and X-ray Diffraction (XRD) analysis. Remarkable improvement for removal of methylene blue (99% removal) was found within 3 h adsorption time with a MLNR/AAc-BiFeO3 hydrogel composite as compared to the pristine hydrogel. A synergistic mode of dye removal by adsorption and photodegradation is proposed. Based on the isotherm and kinetic study conducted, it was found that Freundlich isotherm model and a pseudo second-order kinetic model was best fitted for adsorption of MB dye. The MLNR/AAc-BiFeO3 composite maintains its removal efficiency after 5 cycles without the necessity of post-treatment separation. Therefore, it is crucial to note that the resultant low-cost MLNR/AAc-BiFeO3 hydrogel composite in this study offers excellent potential for water and wastewater treatment applications with improved recyclability and recovery.

Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial.

AIMS: To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care. DESIGN: Two-arm cluster-randomized controlled effectiveness trial across 19 sites with follow-up at 4-week, 3-month, and 6-month. SETTING: Stop smoking services operating in public hospitals in Malaysia. PARTICIPANTS: Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition. INTERVENTION AND COMPARATOR: The intervention consisted of training stop-smoking practitioners to deliver support and follow-up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow-up). MEASUREMENTS: The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired-air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO-verified tobacco smoking abstinence up to 4 weeks and 3 months. RESULTS: Follow-up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6-month follow-up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention-to-treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow-up-only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22-20.77, P = 0.025) and 1.70, (95% CI = 0.25-11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow-ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis. CONCLUSIONS: On an intention-to-treat analysis with missing-equals-smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow-up rates.

Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.

INTRODUCTION: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. METHODS: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR). RESULTS: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes. CONCLUSIONS: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.